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. 2017 Sep;9(9):3062-3068.
doi: 10.21037/jtd.2017.08.99.

Transmanubrial osteomuscular sparing approach for resection of cervico-thoracic lesions

Xufeng Pan  1 , Chang Gu  1 , Rui Wang  1 , Heng Zhao  1 , Jun Yang  1 , Jianxin Shi  1
Affiliations

Transmanubrial osteomuscular sparing approach for resection of cervico-thoracic lesions

Xufeng Pan et al. J Thorac Dis. 2017 Sep.

Abstract

Background: To review our experience of transmanubrial osteomuscular sparing approach (TMA) for resection of various lesions involving the thoracic inlet and to prove the feasibility and safety of the approach.

Methods: Retrospective review of 58 consecutive cases, from April 2007 to January 2016, with surgical resection of cervico-thoracic lesions via TMA.

Results: There were 22 neurogenic tumors, 21 bronchogenic tumors, and 15 other cases in the study. There was no intraoperative or postoperative mortality. Mean postoperative stay was 10.5 days (3-33 days). Mean operation time was 179.0 mins (57-328 mins) and the mean volume of blood loss for bronchogenic tumors was 900 mL, which was similar to non-bronchogenic tumors (474 mL, P=0.103). Moreover, patients with malignant tumors had more intraoperative blood loss than patients with benign diseases did (847 versus 194 mL, P=0.001). R0 resection was achieved in 28 of 33 (84.8%) malignant cases. Tumor size was related to incomplete resection (8.19 vs. 5.72 cm, P=0.023) in malignancy. Five (8.6%) cases were complicated with chylothorax and all occurred in patients with left incision. All of 21 cases (100%) with brachial plexus compression symptom were relieved after surgery and 3 of 4 (75%) cases with Horner's syndrome were ameliorated postoperatively.

Conclusions: TMA can be carried out safely in treating various cervico-thoracic lesions with good resection rate. Left side procedure should be cautious of thoracic duct injury.

Keywords: Transmanubrial osteomuscular sparing approach (TMA); complication; surgical technique.

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
“L” shape incision without shoulder deformities.
Figure 2
Figure 2
Chest CT showing the mass had intimate relationship with surrounding structures.
Figure 3
Figure 3
An anatomical diagram to show preventative ligation of thoracic duct.
See this image and copyright information in PMC

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