| Abstrakt: |
Objectives: Tumors arising in the thoracic inlet and superior mediastinum present a difficult problem of surgical access. Standard approaches from below offer limited exposure to the neurovascular structure superior to the tumor and other techniques involve thoracotomy and resection of part of the clavicle or manubrium with their associated increased morbidity. Our objective was to describe an approach with excellent access and minimal morbidity.Methods: A retrospective study of 9 years experience with 27 consecutive operations in 26 patients, the majority presenting with severe symptoms or life-threatening tumor. Sixteen patients had malignant tumors and 10 had benign pathology. Fifteen patients were either self-referrals or tertiary referrals from other hospitals where their disease was deemed inoperable with local facilities. Fourteen patients had presented with recurrent tumor after previous surgery elsewhere. All patients had advanced disease (stage III, IV).Results: Fifteen tumors were resected completely and a further 8 had near total clearance with equal relief of symptoms. Major complications consisted of 2 postoperative hemorrhages, 1 chylothorax, and 1 persistent pleural effusion requiring multiple drainage. None of our patients had acute respiratory distress syndrome or significant functional shoulder problems. The median in-patient stay was 6 days.Conclusions: The anterior thoraco-cervical approach offers excellent exposure for the resection of neurogenic, metastatic thyroid, or other tumors of the root of the neck and superior mediastinum. The procedure is associated with minimal morbidity and a short hospital stay. [Copyright &y& Elsevier] |
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