Resection of superior sulcus cancers (anterior approach)

Tumors of superior sulcus are defined as primary lung cancers involving one or more structures of the apex of the thoracic cavity. Surgical access of lung tumors invading adjacent organs is classically performed through a postero-lateral thoracotomy; however, in case of proven or suspected infiltration of anterior cervico-mediastinal structures, an anterior approach should be considered. Division of the first rib cartilage and of the costoclavicular ligament, coupled to a manubriotomy or a partial sternotomy gives wide access to cervico-mediastinal structures. Through this wide anterior approach, vascular, osseous and/or nervous structures of the cervico thoracic junction are isolated and resected, as necessary. Once the mediastinum has been freed from tumoral invasion, anatomical lung resection and mediastinal lymphadenectomy are performed. The anterior approach is a useful surgical access in case of apical tumour invading anterior structures of the cervicothoracic junction and the preservation of the sterno-clavicular joint gives satisfactory aesthetic and functional results. The need for a complementary second posterior incision, however, is often required to complete parietal and/or pulmonary resection.