Superior sulcus resection
This presentation is the property of its rightful owner.
Sponsored Links
1 / 28

Superior Sulcus Resection PowerPoint PPT Presentation


  • 260 Views
  • Uploaded on
  • Presentation posted in: General

Superior Sulcus Resection. G. Alexander Patterson, MD Evarts A. Graham Professor of Surgery Chief, Division of Cardiothoracic Surgery. Superior Sulcus Tumors. Evaluated116 patients Eligible101 patients Completed Induction Rx93% Thoractomy81% 1 operative mortality.

Download Presentation

Superior Sulcus Resection

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Superior sulcus resection

Superior Sulcus Resection

G. Alexander Patterson, MD

Evarts A. Graham Professor of Surgery

Chief, Division of Cardiothoracic Surgery


Superior sulcus resection

Superior Sulcus Tumors

  • Evaluated116 patients

  • Eligible101 patients

    • Completed Induction Rx93%

    • Thoractomy81%

      • 1 operative mortality

SWOG 9416, JTCVS 2001; 121: 472


Superior sulcus resection

Superior Sulcus Tumors

SWOG 9416, JTCVS 2001; 121: 472


Requirement for cure

Requirement for Cure

Accurate Staging

Localized Disease

Complete Resection


Surgical approaches for superior sulcus tumor

Surgical Approaches for Superior Sulcus Tumor

  • Posterolateral (Shaw - Paulson)

  • Anterior cervicothoracic (Dartevelle)

  • Hemi-clamshell (Burt)

  • Anteroposterior “hook” (Niwa)

  • VATS - Posterior


Superior sulcus resection

de Perrot, M et al. JTCVS 2012; 144:72-80


L d squamous cell ca

L. D.Squamous Cell Ca

T3 N0


Posterolateral approach

Initial thoracotomy determines resectability

Anterior rib resection

facilitates posterior rib detachment

Posterolateral Approach


Superior sulcus resection

Dissection, resection of involved S.C. artery

Dissection, neurolysis,

resection of involved

T1C8 nerve roots

Posterolateral Approach

Excellent exposure for final stage of chest wall excision


Preliminary supraclavicular exploration

Dissection of:

Supraclavicular nodes

S.C. artery

Brachial plexus

Scalene muscles

Phrenic nerve

Determine resectability prior to morbidity of major resection

Preliminary Supraclavicular Exploration


Anterior cervicothoracic approach

Anterior Cervicothoracic Approach

Excellent Exposure for Anterior Lesions

Incision anterior sternomastoid

inferior to clavicle into D.P. groove

Clavicular resection

exposes throacic inlet


Hemi clamshell approach

Hemi-Clamshell Approach

Excellent Exposure for Anterior Lesions

Initial anterolateral

thoracotomy

Extension after

resectability confirmed


T 3 superior sulcus

T3 Superior Sulcus

  • Adverse prognostic factors:

    • Horner’s syndrome

    • N2, N3 disease

    • Incomplete resection

      • 9% 5yr survival

Ginsberg, Ann Thor Surg 1994; 57:1440


Survival

Superior Sulcus Tumors

Survival

Gomez D, Cancer 2012 38(0) 50, 2012 Jan


Summary

Summary

  • Detailed History

  • Accurate Staging

  • Neoadjuvant chemorads

  • Precise Exploration

  • Complete resection


What treatment regimen provides the best long term survival for resectable superior sulcus tumors

What treatment regimen provides the best long term survival for resectable superior sulcus tumors?

  • Resection + adjuvant radiation

  • Resection + adjuvant chemorads

  • Resection alone

  • Neoadjuvant chemorads + resection

  • Neoadjuvant chemorads + resection + adjuvant chemo


All of the following are absolute contraindications to potentially curative resection except

All of the following are absolute contraindications to potentially curative resection except:

  • Extrathoracic metastatic disease

  • Vertebral column involvement

  • Tracheal involvement

  • Brachial plexus invasion


Which of the following is a recognized complication following resection of superior sulcus tumors

Which of the following is a recognized complication following resection of superior sulcus tumors

  • Horner’s

  • CSF leak

  • Dejerine syndrome

  • All of the above

  • None of the above


  • Login