Trans-upper-sternal Approach in Resection of Cervicothoracic Junction Tumors_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANGZhao-lei ,  WANGMing-song , XIAOHai-bo , LIGuo-qing , HUFENG-qing , XIEXiao , HURui , JIANGLian-yong , MEIJu

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, P. R. China;

Corresponding author：

WANGMing-song, Email: wms0210@163.com

Keywords：

Cervicothoracic junction tumor; Upper-sternal; Resection; Effect

DOI：

10.7507/1007-4848.20160209

Video：

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Objective To summarize the experience of applying trans-upper-sternal approach in resection of cervicothoracic junction tumors. Methods We retrospectively analyzed the clinical data of 32 patients with cervicothoracic junction tumors received surgical resection through the trans-upper-sternal approach in our hospital from March 2012 through March 2015. There were 20 males and 12 females at age of 18 to 76(44.8±11.3) years. Results All patients successfully underwent tumor resection through trans-upper-sternal approach. No patient required to convert to full sternotomy during the surgery. There was no early death, re-operation, or incision infection in the perioperation. Hornor syndrome occurred in 1 patient, hoarseness in 3 patients, and lymphatic leakage in 1 patient in the early postoperative time. Postoperative in-hospital time ranged from 3 to 7 days. No patient needed blood transfusion. Pathological examination showed that 17 patients had malignant tumor. Among them, 15 patients received postoperative radiotherapy or chemotherapy. Follow-up duration ranged from 6 to 42 months. All patients were alive, and no limbs disturbance occurred. Conclusion Applying trans-upper-sternal approach is safe, feasible and effective for the resection of cervicothoracic junction tumor with satisfactory outcome, less trauma, better cosmetolgy, and faster recovery.

Citation： JIANGZhao-lei, WANGMing-song, XIAOHai-bo, LIGuo-qing, HUFENG-qing, XIEXiao, HURui, JIANGLian-yong, MEIJu. Trans-upper-sternal Approach in Resection of Cervicothoracic Junction Tumors. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(9): 873-876. doi: 10.7507/1007-4848.20160209 Copy

1.	施建新, 高成新, 孙德魁等.胸顶部肿瘤外科治疗27例临床分析.中华外科杂志, 2004, 42(2):72-74.
2.	Dalbayrak S, Yaman O, Yilmaz M, et al. Results of the transsternal approach to cervicothoracic junction lesions. Turk Neurosurg, 2014, 24(5):720-725.
3.	Christison-Lagay ER, Darcy DG, Stanelle EJ, et al. "Trap-door" and "clamshell" surgical approaches for the management of pediatric tumors of thecervicothoracic junction and mediastinum. J Pediatr Surg, 2014, 49(1):172-177.
4.	Aigner C, Hoda MA, Klepetko W. Combined cervicothoracic approaches for complex mediastinal masses. Thorac Surg Clin, 2009, 19(1):107-112.
5.	Spaggiari L, Pastorino U. Transmanubrial approach with antero-lateral thoracotomy for apical chest tumor. Ann Thorac Surg, 1999, 68(2):590-593.
6.	Park HY, Lee SH, Park SJ, et al. Surgical management with radiation therapy for metastatic spinal tumors located on cervicothoracic junction:a single center study. J Korean Neurosurg Soc, 2015, 57 (1):42-49.
7.	Korst RJ, Burt ME. Cervicothoracic tumors:results of resection by the "hemi-clamshell" approach. J Thorac Cardiovasc Surg, 1998, 115(2):286-295.
8.	Wang VY, Chou D. The cervicothoracic junction. Neurosurg Clin N Am, 2007, 18(2):365-371.
9.	Baker JF, Shafqat A, Devitt A, et al. Surgical management of metastatic lesions at the cervicothoracic junction. J Craniovertebr Junction Spine, 2015, 6(3):115-119.
10.	Spaggiari L, Calabrese L, Gioacchino G, et al. Cervico-thoracic tumors resection through transmanubrial osteomuscular sparing approach. Eur J Cardiothorac Surg, 1999, 16(5):564-567.
11.	Le H, Balabhadra R, Park J, et al. Surgical treatment of tumors involving the cervicothoracic junction. Neurosurg Focus, 2003, 15(5):E3.
12.	Rusca M, Carbognani P, Bobbio P. The modified "hemi-clamshell" approach for tumors of the cervicothoracic junction. Ann Thorac Surg, 2000, 69(6):1961-1963.
13.	Matsuguma H, Nakahara R, Ishikawa Y, et al. Transmanubrial osteomuscular sparing approach for lung cancer invading the anterior part of the thoracic inlet. Gen Thorac Cardiovasc Surg, 2010, 58(3):149-154.
14.	Huang YX, Tian NF, Chi YL, et al. Mini-open anterior approach to the cervicothoracic junction:a cadaveric study. Eur Spine J, 2013, 22(7):1533-1538.
15.	Radek A, Maciejczak A, Kowalewski J, et al. Trans-sternal approach to the cervicothoracic junction. Neurol Neurochir Pol, 1999, 33(5):1201-1213.
16.	Lebreton G, Baste JM, Thumerel M, et al. The hemiclamshell approach in thoracic surgery:indications and associated morbidity in 50 patients. Interact Cardiovasc Thorac Surg, 2009, 9(6):965-969.
17.	Luciani GB, Lucchese G. Minimal-access median sternotomy for aortic valve replacement. J Thorac Dis, 2013, 5(Suppl 6):S650-S653.
18.	Raja SG, Benedetto U, Amrani M. Aortic valve replacement through J-shaped partial upper sternotomy. J Thorac Dis, 2013, 5 (Suppl 6):S662-S668.
19.	Grunenwald D, Spaggiari L. Transmanubrial osteomuscular sparing approach for apical chest tumors. Ann Thorac Surg, 1997, 63(2):563-566.
20.	杨立信, 赵铁军, 陆超敬, 等.劈开胸骨柄绕胸锁关节切口切除颈胸交界部肿瘤.中华胸心血管外科杂志, 2012, 28(2):106-107.

1. 施建新, 高成新, 孙德魁等.胸顶部肿瘤外科治疗27例临床分析.中华外科杂志, 2004, 42(2):72-74.
2. Dalbayrak S, Yaman O, Yilmaz M, et al. Results of the transsternal approach to cervicothoracic junction lesions. Turk Neurosurg, 2014, 24(5):720-725.
3. Christison-Lagay ER, Darcy DG, Stanelle EJ, et al. "Trap-door" and "clamshell" surgical approaches for the management of pediatric tumors of thecervicothoracic junction and mediastinum. J Pediatr Surg, 2014, 49(1):172-177.
4. Aigner C, Hoda MA, Klepetko W. Combined cervicothoracic approaches for complex mediastinal masses. Thorac Surg Clin, 2009, 19(1):107-112.
5. Spaggiari L, Pastorino U. Transmanubrial approach with antero-lateral thoracotomy for apical chest tumor. Ann Thorac Surg, 1999, 68(2):590-593.
6. Park HY, Lee SH, Park SJ, et al. Surgical management with radiation therapy for metastatic spinal tumors located on cervicothoracic junction:a single center study. J Korean Neurosurg Soc, 2015, 57 (1):42-49.
7. Korst RJ, Burt ME. Cervicothoracic tumors:results of resection by the "hemi-clamshell" approach. J Thorac Cardiovasc Surg, 1998, 115(2):286-295.
8. Wang VY, Chou D. The cervicothoracic junction. Neurosurg Clin N Am, 2007, 18(2):365-371.
9. Baker JF, Shafqat A, Devitt A, et al. Surgical management of metastatic lesions at the cervicothoracic junction. J Craniovertebr Junction Spine, 2015, 6(3):115-119.
10. Spaggiari L, Calabrese L, Gioacchino G, et al. Cervico-thoracic tumors resection through transmanubrial osteomuscular sparing approach. Eur J Cardiothorac Surg, 1999, 16(5):564-567.
11. Le H, Balabhadra R, Park J, et al. Surgical treatment of tumors involving the cervicothoracic junction. Neurosurg Focus, 2003, 15(5):E3.
12. Rusca M, Carbognani P, Bobbio P. The modified "hemi-clamshell" approach for tumors of the cervicothoracic junction. Ann Thorac Surg, 2000, 69(6):1961-1963.
13. Matsuguma H, Nakahara R, Ishikawa Y, et al. Transmanubrial osteomuscular sparing approach for lung cancer invading the anterior part of the thoracic inlet. Gen Thorac Cardiovasc Surg, 2010, 58(3):149-154.
14. Huang YX, Tian NF, Chi YL, et al. Mini-open anterior approach to the cervicothoracic junction:a cadaveric study. Eur Spine J, 2013, 22(7):1533-1538.
15. Radek A, Maciejczak A, Kowalewski J, et al. Trans-sternal approach to the cervicothoracic junction. Neurol Neurochir Pol, 1999, 33(5):1201-1213.
16. Lebreton G, Baste JM, Thumerel M, et al. The hemiclamshell approach in thoracic surgery:indications and associated morbidity in 50 patients. Interact Cardiovasc Thorac Surg, 2009, 9(6):965-969.
17. Luciani GB, Lucchese G. Minimal-access median sternotomy for aortic valve replacement. J Thorac Dis, 2013, 5(Suppl 6):S650-S653.
18. Raja SG, Benedetto U, Amrani M. Aortic valve replacement through J-shaped partial upper sternotomy. J Thorac Dis, 2013, 5 (Suppl 6):S662-S668.
19. Grunenwald D, Spaggiari L. Transmanubrial osteomuscular sparing approach for apical chest tumors. Ann Thorac Surg, 1997, 63(2):563-566.
20. 杨立信, 赵铁军, 陆超敬, 等.劈开胸骨柄绕胸锁关节切口切除颈胸交界部肿瘤.中华胸心血管外科杂志, 2012, 28(2):106-107.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Trans-upper-sternal Approach in Resection of Cervicothoracic Junction Tumors

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