Chest wall resections for sulcus superior tumors.

J Thorac Dis

Department of Cardiothoracic Surgery, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.

Published: February 2024

AI Article Synopsis

  • Chemoradiotherapy followed by surgical resection is the standard treatment for superior sulcus tumors (SST), which invade the chest wall and often require complex surgical techniques.
  • The surgery for SST is challenging due to higher risks of complications, the tumor's anatomical location, and potential variations in surgical approach, highlighting the importance of careful patient selection and multidisciplinary care.
  • Advancements in surgical techniques, including minimally invasive options and 3D imaging, are evolving to enhance recovery and reduce morbidity, while chest wall reconstruction, when needed, should use appropriate materials for structural support.

Article Abstract

Chemoradiotherapy followed by surgical resection (trimodality therapy) is a guideline recommended treatment for sulcus superior tumors (SST). By definition, SSTs invade the chest wall and therefore require en-bloc chest wall resection with the upper lung lobe or segments. The addition of a chest wall resection, potentially results in higher morbidity and mortality rates when compared to standard anatomical pulmonary resection. This, together with their anatomical location in the thoracic outlet, and varying grades of fibrosis and adhesions resulting from induction chemoradiotherapy in the operation field, make surgery challenging. Depending on the exact location of the tumor and extent to which it invades the surrounding structures, the preferred surgical approach may vary, e.g., anterior, posterolateral, hemi-clamshell, or combined approach; all with their own potential advantages and morbidities. Careful patient selection, adequate staging and discussion in a multidisciplinary tumor board in a center experienced in complex thoracic oncology leads to the best long-term survival outcomes with the least morbidity and mortality. Enhanced recovery guidelines are now available for thoracic surgery, promoting faster recovery and helping to minimize complications and morbidity, including infections and thoracotomy pain. Although minimally invasive surgery can enhance recovery and reduce chest wall morbidity, and is in widespread use in thoracic oncology, its use for SST has been limited. However, this is an evolving area and hybrid surgical approaches (including use of the robot) are being reported. Chest wall reconstruction is rarely necessary, but if so, the prosthetic materials are preferably radiolucent/non-scattering, rigid enough while still being somewhat flexible, and inert, providing structural support, allowing chest wall movement, and closing defects, while inciting a limited inflammatory response. New techniques such as 3D image reconstructions/volume rendering, 3D-printing, and virtual reality modules may help pre-operative planning and informed patient consent.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10944789PMC
http://dx.doi.org/10.21037/jtd-23-828DOI Listing

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