Patient reported long-term quality of life and symptom resolution after first rib resection and anterior scalenectomy

The aim of this study was to evaluate patient-reported long-term outcomes in patients with neurogenic thoracic outlet syndrome (nTOS) and venous TOS (vTOS), who underwent first rib resection and anterior scalenectomy (FRRAS).

Single institution, retrospective chart review from 2015 to 2025 was completed after obtaining institutional review board approval. Baseline demographic and clinical data were collected for patients who underwent surgery at least 1 year earlier. A five-question quality of life (QOL) survey was provided to patients through phone call or the electronic health record. Descriptive statistics including number (%) of categorical factors or median and interquartile range of continuous factors were reported. Differences between TOS subtypes were assessed using Fisher exact test (categorical) or rank-sum tests (continuous).

Of the 204 patients who underwent FRRAS, 104 completed our survey (57/114 nTOS and 47/90 vTOS). Patients with nTOS had significantly longer preoperative symptom duration (median [interquartile range], 24 [12-60] vs 2 [1-10] months for vTOS; P < .001) with no other differences between groups. In nTOS, most patients (43/57, 75.4%) indicated improved QOL, regardless of the surgical approach. Although most patients did not have recurrent symptoms (32/57, 56.1%), those who did were more likely to be older (median age, 39 [35-46] vs 27 [17-39] years; P = .003). 30/57 patients (52.6%) reported ongoing paresthesias, though 47/57 patients (82.5%) did not require chronic medications. Patients requiring chronic medication were more likely to have undergone reoperative surgery (30% vs 4.3%; P = .033). Similarly, in vTOS, most patients (41/47, 87.2%) reported improved QOL, regardless of the surgical approach. Most veins (45/47, 95.7%) were patent at the time of follow-up and did not affect outcome. Younger patients were more likely to have improvement (median, 31 [22-41] vs 47 [44-50] years; P = .015). Patients with recurrent symptoms, paresthesias, chronic medication use, or ongoing physical therapy/occupational therapy needs were significantly older (median age: 49 [43-53] vs 30 [21-39] years, P < .001; 42 [31-48] vs 30 [20-41] years, P = .027; 52 [50-55] vs 32 [22-41] years, P = .007; and 43 [41-51] vs 31 [21-41] years, P = .014).

Patient-reported long-term outcomes are favorable for patients with nTOS and vTOS undergoing FRRAS. Our study highlights differences in long-term QOL by age, with younger patients having longer-term symptom-free experiences. Although a small proportion of patients have recurrent symptoms, most report improved QOL.