Changes in the treatment of Pancoast tumors

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Presentation transcript:

Changes in the treatment of Pancoast tumors Frank C Detterbeck, MD The Annals of Thoracic Surgery Volume 75, Issue 6, Pages 1990-1997 (June 2003) DOI: 10.1016/S0003-4975(03)00134-6

Fig 1 High posterior thoracotomy. Incision extends around tip of scapula, midway between posterior edge of scapula and spinous processes, up to level of C7 (dark dashed line). (From Dartevelle P, Macchiarini P. Resection of superior sulcus tumors. In: Kaiser LR, Kron IL, Spray TL, eds. Mastery of cardiothoracic surgery. Philadelphia: Lippincott-Raven Publishers, 1998:257–65 [9], by permission of Lippincott Williams & Wilkins.) The Annals of Thoracic Surgery 2003 75, 1990-1997DOI: (10.1016/S0003-4975(03)00134-6)

Fig 2 Anterior transcervical–thoracic and cervicothoracic transmanubrial incisions. Incision along anterior border of sternocleidomastoid muscle is carried either directly over clavicle (transcervical incision) or two fingerbreadths below inferior border of clavicle (transmanubrial incision). (From Dartevelle P, Macchiarini P. Resection of superior sulcus tumors. In: Kaiser LR, Kron IL, Spray TL, eds. Mastery of cardiothoracic surgery. Philadelphia: Lippincott-Raven Publishers, 1998:257–65 [9], by permission of Lippincott Williams & Wilkins.) The Annals of Thoracic Surgery 2003 75, 1990-1997DOI: (10.1016/S0003-4975(03)00134-6)

Fig 3 Anterior transsternal approach. The incision involves an upper median sternotomy (1), an extension into the anterior 4th intercostal space (2), and a transverse incision above the clavicle at the base of the neck (3). (From Dartevelle P, Macchiarini P. Resection of superior sulcus tumors. In: Kaiser LR, Kron IL, Spray TL, eds. Mastery of cardiothoracic surgery. Philadelphia: Lippincott-Raven Publishers, 1998:257–65 [9], by permission of Lippincott Williams & Wilkins.) The Annals of Thoracic Surgery 2003 75, 1990-1997DOI: (10.1016/S0003-4975(03)00134-6)

Fig 4 Multilevel thoracic vertebrectomy and laminectomy, reconstruction with methylmethacrylate, placement of anterior locking plate and screw construct, and posterior fixation with hooks and rods. (Reprinted with permission from The Society of Thoracic Surgeons [Ann Thorac Surg 1999, 68, 1778–85] [34].) The Annals of Thoracic Surgery 2003 75, 1990-1997DOI: (10.1016/S0003-4975(03)00134-6)

Fig 5 Overall survival according to status of surgical margins in patients undergoing resection of a lung cancer involving the vertebral bodies. (Neg. = negative; Pos. = positive.) (Reprinted with permission from The Society of Thoracic Surgeons [Ann Thorac Surg 1999, 68, 1778–85] [34].) The Annals of Thoracic Surgery 2003 75, 1990-1997DOI: (10.1016/S0003-4975(03)00134-6)

Fig 6 Overall survival by T stage for all eligible patients with follow-up in a prospective trial of preoperative chemotherapy and radiotherapy. (From Rusch VW, et al, J Thorac Cardiovasc Surg; 2001;121:472–83 [35], with permission.) The Annals of Thoracic Surgery 2003 75, 1990-1997DOI: (10.1016/S0003-4975(03)00134-6)