Transmanubrial osteomuscular sparing approach: Different indications

Abstract

The surgery of the cervico-thoracic inlet is a challenge for the thoracic surgeon. Several authors have described different approaches with different degrees of invasiveness to this anatomical area. We used the transmanubrial osteomuscular sparing approach described by Grünenwald and Spaggiari for six patients with five different indications: 1) left anterior Pancoast tumor; 2) glomus tumor originating from the inferior trunk (C8-T1 roots) of the right brachial plexus; 3) T1 vertebral tumor; 4) right internal jugular chain, Pirogoff confluence and subclavian artery metastatic lymph nodes from thyroid carcinoma; 5) chondrosarcoma of the first left rib. The results have been satisfactory from a surgical point of view, considering that the approach gave a good exposure of the operative field (especially at the cervical level), without cosmetic problems or functional limitations. In our experience, the transmanubrial osteomuscular sparing approach is a valid technique for the treatment of several kinds of tumors of the cervico-thoracic inlet, giving a good exposure of the operative field. In the case of anterior Pancoast tumors, the upper lobectomy may necessitate a further axillary thoracotomy, when fissural adherences are present. © 2010 Published by European Association for Cardio-Thoracic Surgery.