Background: The purpose of this study was to evaluate long-term outcomes after subclavian artery resection and reconstruction during surgery for thoracic inlet cancer through the anterior transclavicular approach. Methods: Between 1985 and 2011, 72 patients (51 men and 21 women; mean age, 51 years) underwent en bloc resection of thoracic inlet non-small cell lung cancer (n = 59), sarcoma (n = 10), breast carcinoma (n = 2) or thyroid carcinoma (n = 1) involving the subclavian artery. An L-shaped transclavicular cervicothoracotomy was performed, with posterolateral thoracotomy in 14 patients or a posterior midline approach in 13 patients. Resection extended to the chest wall (more than two ribs, n = 53), lung (n = 66), and spine (n = 13). Revascularization was by end-to-end anastomosis (n = 40), polytetrafluoroethylene graft interposition (n = 25), subclavian-to-common carotid artery transposition (n = 6), or grafting of the autologous superficial femoral artery in an anterolateral thigh free flap (n = 1). Complete R0 resection was achieved in 65 patients and microscopic R1 resection in 7 patients. Postoperative radiation therapy was given to 46 patients. Results: There were no cases of postoperative death, neurologic sequelae, graft infection or occlusion, or limb ischemia. Postoperative morbidity consisted of pneumonia (n = 16), phrenic nerve palsy (n = 2), recurrent nerve palsy (n = 2), bleeding (n = 3), acute pulmonary embolism (n = 1), cerebrospinal fluid leakage (n = 1), chylothorax (n = 1), and wound infection (n = 1). Five-year survival and disease-free survival rates were 28% and 20%, respectively. Long-term survival was not observed after R1 resection. Conclusions: Subclavian arteries invaded by thoracic inlet malignancies can be safely resected and reconstructed through the anterior transclavicular approach, with good long-term survival provided complete R0 resection is achieved. © 2013 by The Society of Thoracic Surgeons.
Lahon, B., Mercier, O., Fadel, E., Mussot, S., Fabre, D., Hamdi, S., … Dartevelle, P. (2013). Subclavian artery resection and reconstruction for thoracic inlet cancer: 25 years of experience. In Annals of Thoracic Surgery (Vol. 96, pp. 983–989). https://doi.org/10.1016/j.athoracsur.2013.04.032