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Editorial
. 2021 Oct;9(20):1603.
doi: 10.21037/atm-21-4698.

Surgical resection of superior pulmonary sulcus tumor after neoadjuvant chemoradiation via the anterior transmanubrial approach: a case report

Feichao Bao  1 , Fenghao Yu  1 , Xiuxiu Hao  1 , Zhitao Gu  1 , Seong Yong Park  2 , Francesco Grossi  3 , Wentao Fang  1
Affiliations
Editorial

Surgical resection of superior pulmonary sulcus tumor after neoadjuvant chemoradiation via the anterior transmanubrial approach: a case report

Feichao Bao et al. Ann Transl Med. 2021 Oct.

Abstract

Superior pulmonary sulcus tumor is a cancer arising in the apex of the lung that with potential invasion of the brachial plexus, upper ribs, vertebrae, subclavian vessels, and stellate ganglion. Induction concurrent chemoradiotherapy followed by radical surgical resection with lobectomy combined with any structures in the thoracic inlet invaded by tumor and thorough mediastinal lymph node dissection is the preferred treatment. Both anterior and posterior approaches are applied for resection. Here, we report a 61-year-old man with an 8.6 cm × 5.1 cm mass arising from the right upper lobe invading the apex of the chest wall. Brachial plexus magnetic resonance imaging suggested tumor invasion of the inferior trunk of the brachial plexus, anterior portion of the first 2 ribs, and suspicious involvement of the subclavian artery. Biopsy of the mass showed stage cT4N2M0, IIIB, poorly differentiated adenocarcinoma. The patient was treated by induction concurrent chemoradiotherapy, which was followed by surgical resection of the right upper lobe and the affected chest wall via the transmanubrial approach. The patient suffered prolonged postoperative air leak and empyema. After continuous chest tube drainage and intrapleural fibrinolytic therapy, he recovered well and was discharged safely. Final pathology showed no viable residue tumor, pathologic complete response of the tumor to induction treatment, a tumor size of 4.1 cm, and no lymph nodes; therefore, the final stage was ypT0N0M0. The transmanubrial approach is feasible for resection of tumor invading the branches of the subclavian artery; however, postoperative empyema which might have resulted from prolonged air leak should be carefully treated by meticulous air leak management.

Keywords: Pancoast tumor; air leak; case report; multidisciplinary treatment; superior pulmonary sulcus tumor.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://dx.doi.org/10.21037/atm-21-4698). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Computed tomography (CT) revealed a mass arising from the right upper lobe invading the thoracic inlet. (A) Images before concurrent chemoradiotherapy; (B) images after concurrent chemoradiotherapy.
Figure 2
Figure 2
Brachial plexus MRI revealed superior pulmonary sulcus tumor compressing the inferior branch of the brachial plexus. (A) Images before concurrent chemoradiotherapy; (B) images after concurrent chemoradiotherapy.
Figure 3
Figure 3
The anatomy of the chest after surgical resection of the tumor and the affected chest wall.
See this image and copyright information in PMC

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