Video-assisted pulmonary lobectomy combined with transmanubrial approach for anterior Pancoast tumor resection: Case report

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Background: The mini-ivasive approach to superior sulcus tumors is an uncommon procedure that is still far from standardization. We describe a hybrid surgical technique to approach "en block" chest resection and pulmonary lobectomy for anterior superior sulcus tumors. Case Presentation: A patient affected by right anterior Pancoast tumor surgically staged as cT4N0M0 (suspected anonymous vein invasion) underwent chemo-radiation induction therapy with satisfactory tumor reduction. The surgical operation comprised an initial VATS approach to the hilar structures followed by a limited C-shaped anterior contra-incision; finally, the right upper lobe "en block" with the anterior part of the first and second rib was removed. The whole procedure was conducted with the patient in the supine position; no rib retractors were used. The definitive stage was ypT0N0M0. The patient had an uneventful hospital stay and at the 9 months follow-up she was free from disease and post-thoracotomy syndrome. Conclusions: In our opinion such hybrid VATS procedure has several advantages: starting with thoracoscopy it is possibleto exclude previously undetected pleural dissemination and to precisely define the tumor location as well as limits of the thoracic wall resection; time could be spared maintaining the patients in the supine position for both surgical times; postoperative pain and post-thoracotomy syndrome could be minimized avoiding the use of any rib retractor.

Original languageEnglish
Article number65
JournalJournal of Cardiothoracic Surgery
Issue number1
Publication statusPublished - Apr 14 2016


  • Anterior Pancoast
  • Chest wall
  • Lung cancer
  • Transmanubrial approach
  • VATS lobectomy

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine


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