Chest wall resections for sulcus superior tumors

Area of Science:

• Thoracic Oncology
• Surgical Oncology
• Neurosurgery

Background:

• Superior sulcus tumors (SSTs) require trimodality therapy (chemoradiotherapy followed by surgical resection).
• SSTs invade the chest wall, necessitating en-bloc resection of the chest wall and upper lung lobe.
• Surgical resection of SSTs is challenging due to chest wall invasion, thoracic outlet location, and post-treatment fibrosis.

Purpose of the Study:

• To review the challenges and current approaches in surgical resection of superior sulcus tumors.
• To highlight the importance of multidisciplinary care and patient selection for optimal outcomes.
• To discuss evolving surgical techniques and reconstruction methods for SSTs.

Main Methods:

• Review of surgical approaches for SSTs, including anterior, posterolateral, and hemi-clamshell techniques.
• Discussion of the role of multidisciplinary tumor boards and experienced centers in managing complex thoracic oncology cases.
• Exploration of enhanced recovery guidelines and minimally invasive/hybrid surgical techniques for SSTs.

Main Results:

• Surgical resection of SSTs, while complex, can achieve optimal long-term survival with careful patient selection and multidisciplinary management.
• Various surgical approaches exist, each with specific advantages and morbidities.
• Minimally invasive and hybrid approaches are emerging but have limited use in SSTs currently.

Conclusions:

• Multidisciplinary care and experienced centers are crucial for managing SSTs to minimize morbidity and mortality.
• Enhanced recovery protocols can improve patient outcomes after complex thoracic surgery.
• Advanced planning tools like 3D reconstruction and printing may aid surgical management and patient consent.