Modified trap-door thoracotomy for malignancies invading the subclavian and innominate vessels

Thirteen patients with malignancies which had invaded the subclavian vessels and/or distal border of the innominate vessels were operated on through modified "trap-door" thoracotomy. The modification is the additional resection of the first rib from inside the thorax. Tumors consisted of thyroid cancer in 5 patients, thymic tumor in 3, Pancoast tumor in 3, and lymphoma in 2. Invaded vessels were on the left side in 9 cases, on the right in 3, and bilateral in one. Subclavian and/or innominate veins were resected in 12 cases and reconstructed in 5. The remaining case was treated with resection of the right innominate and subclavian artery and its vascular reconstruction. Compared to original trap-door thoracotomy, the modification provided a more adequate opening in the chest wall and more extensive exposure of the entire subclavian vessels, which made distal vascular control safe and easy. Postoperative complications occurred in one patient, who suffered chylothorax. In conclusion, modified trap-door thoracotomy is a viable and useful approach in the resection of malignancies which have invaded the subclavian and/or distal border of the innominate vessels.