Transmanubrial osteomuscular sparing approach: different indications for non-pulmonary malignancies

The transmanubrial osteomuscular sparing approach (TMA) is recommended for surgeries involving or originating from the thoracic outlet structures. We present a series of consecutive patients treated from 2014 to 2024 who underwent oncological thoracic outlet surgery for primary or metastatic (non-pulmonary) malignancies. Overall, 33 patients were included. Our procedures resulted in no mortality, seven complications (21.2%) and all surgeries achieved radical (R0) status. In the hands of experienced professionals, the TMA approach proves to be safe and conservative, enabling radical surgery for tumors of the thoracic outlet. For low-grade tumors, it avoids the need for additional combined surgical access, while for high-grade tumors, it allows for more extensive en bloc resection.