Rib-Sparing Anterior Scalenectomy Versus First Rib Resection for the Treatment of Thoracic Outlet Syndrome.

Area of Science:

• Vascular Surgery
• Neurosurgery
• Thoracic Surgery

Background:

• Thoracic outlet syndrome (TOS) involves compression of neurovascular structures in the thoracic outlet.
• Surgical decompression is indicated for progressive TOS symptoms unresponsive to conservative management.
• Common surgical approaches include first rib resection and anterior scalenectomy, with limited direct comparisons of their associated morbidity.

Purpose of the Study:

• To compare the perioperative complication rates between first rib resection and rib-sparing anterior scalenectomy for thoracic outlet decompression.
• To evaluate the safety and efficacy of these two surgical techniques for TOS.

Main Methods:

• Retrospective cohort study of 191 patients undergoing first-time thoracic outlet decompression.
• Patients were divided into two groups: first rib resection (n=79) and rib-sparing anterior scalenectomy (n=112).
• Comparison of baseline comorbidities, perioperative complications, and 90-day pain relief using paired t-tests and chi-squared tests.

Main Results:

• First rib resection was associated with significantly higher overall complication rates (53.2%) compared to anterior scalenectomy (8.9%).
• Specific complications more frequent with first rib resection included pleural injury, pneumothorax, nerve transection, and vascular injuries.
• Anterior scalenectomy had higher odds of transient phrenic nerve palsy, but overall morbidity was lower.

Conclusions:

• First rib resection for thoracic outlet decompression is linked to a greater incidence of complications, particularly pleural and nerve injuries.
• Rib-sparing anterior scalenectomy demonstrates a lower complication profile compared to first rib resection.
• Future redo surgeries were similarly frequent between the groups.