All of these approaches are valuable and worthwhile, depending on the site of the apical tumor (anterior or posterior). When using an anterior approach, however, if significant posterior chest wall involvement is also present, a combined approach may be necessary, turning the patient after closure of the anterior wound, and completing the excision from the posterior approach. Thoracic surgeons involved in the management of these tumors should have all of these approaches available in their armamentarium. The overall 5-year cure rate following surgical resection of superior sulcus tumors is about 30%. In our experience, when a complete resection is performed, including a lobectomy, the 5-year cure rate is doubled. The results of en bloc resection of adjacent involved organs (subclavian vessels, vertebral body) are less optimistic in most reported series, which may reflect inadequate resections.