Twenty-five years' experience with a trap-door thoracotomy modified with disconnection of the first rib for tumors invading the anterior superior sulcus.

Abstract

A procedure of modified trap-door thoracotomy and our 25 years' experience in 33 patients with tumors invading the anterior superior sulcus are presented. The modified portion of the original trap-door thoracotomy is the disconnection of the first rib from inside the thorax. Tumors consisted of lung cancer in 13 patients, thyroid cancer in 10, thymic tumor in 5, neurogenic tumor in 3, germ cell tumor in 1, and metastatic tumor in 1. Of the 33, 16 patients underwent a combined resection of the invaded organs, which included the brachiocephalic and subclavian veins in 4 patients, brachiocephalic vein in 3, thoracic wall in 6, trachea in 2, and trachea and brachiocephalic artery in 1. Combined resections of the trachea in the total 3 patients were treated with a sleeve resection and reconstruction, and those of the brachiocephalic and subclavian veins in 2 patients and brachiocephalic artery in 1 were reconstructed by a vessel graft. Compared with the original trap-door thoracotomy, the additional disconnection of the first rib from inside the thorax provided a more adequate opening in the chest wall and more extensive exposure of the entire superior sulcus region, which enabled the complete resection of the tumors in all patients. A postoperative complication occurred in 1 patient, who had chylothorax. A trap-door thoracotomy modified with a disconnection of the first rib enabled a sufficient approach for resection of tumors invading the anterior superior sulcus.