The hemiclamshell approach in thoracic surgery: indications and associated morbidity in 50 patients

Area of Science:

• Thoracic Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• The hemiclamshell (HCS) approach, a combination of partial sternotomy and thoracotomy, is utilized for extensive thoracic resections.
• Evaluating the indications and outcomes of the HCS approach is crucial for optimizing patient care in complex thoracic surgeries.

Purpose of the Study:

• To retrospectively assess the indications, morbidity, and outcomes of the hemiclamshell (HCS) surgical approach.
• To analyze patient results at one month and one year post-procedure, focusing on pain, neurological deficits, shoulder dysfunction, and mortality.

Main Methods:

• Retrospective analysis of 50 patients who underwent the HCS procedure between July 1996 and July 2005.
• Data collection included indications for surgery, postoperative complications (morbidity), and patient outcomes (pain, neurological/shoulder defects, mortality) at one month and one year.

Main Results:

• The primary indications for HCS were cervicothoracic junction tumors (46%), apical tumors (38%), chest wall tumors (10%), and bulky tumors (6%).
• One-month mortality was 6%. Complications included chylothorax (2 patients) and phrenic paralysis (1 patient).
• Postoperative pain and shoulder dysfunction were reported by 12% and 10% at one month, decreasing to 6% for both at one year. Analgesic requirements were comparable to other thoracic approaches.

Conclusions:

• The hemiclamshell (HCS) surgical approach is associated with an uncomplicated postoperative course and favorable outcomes.
• This anterior surgical approach provides excellent access for managing large vessels and performing radical mediastinal clearance, making it suitable for apical, cervicothoracic junction, and bulky lung tumors.