The Neurosurgical Management of Pancoast Tumors: Neurological Function and Survival Outcomes With a Brachial Plexus Preserving Operative Technique

Abstract

Background and objectives: Surgical management of Pancoast tumors requires collaboration between thoracic surgeons and neurosurgeons. Minimal literature exists on the management of these patients from a neurosurgical perspective regarding operative technique and its impact on short-term neurological function and long-term survival.

Methods: Patients at a National Cancer Institute-designated cancer center were prospectively enrolled in an Institutional Review Board-approved study. Those patients surgically treated for Pancoast tumors were identified. Patient demographics, tumor characteristics, preoperative and postoperative measurements, and discharge disposition were collected. Outcome measures included neurological function and overall survival. Basic descriptive statistics were performed to summarize cumulative data for each measurement recorded.

Results: Nineteen patients were included in the study. The mean age was 59 + 7.88 years, and 42.11% (n = 8) were female. 43.75% (n = 7) were staged as T3 and 56.25% (n = 9) as T4. 89.47% (n = 17) had preoperative chemoradiotherapy (Table 1). 89.47% (n = 17) and 21.05% (n = 4) presented with upper extremity pain and paresthesia, respectively. 57.89% (n = 11) presented with respiratory symptoms. The mean time from diagnosis to surgery was 143.53 + 39.87 days (Table 2). 100% underwent resection of apical tumor and chest wall, with complete removal achieved in 89.47% (n = 17). Complications occurred in of 21.05% (n = 4) patients, no major complications. Average follow-up was 3.83 + 3.11 years. 10.53% (n = 2) had decrease in motor function from baseline (P = .162), whereas sensation remained intact and unchanged for all patients. 42.11% (n = 8) had tumor recurrence, with an average of 0.91 years from tumor resection. There were 26.32% (n = 5) patients who were deceased at an average of 1.65 + 1.15 years (Table 3).

Conclusion: Our case series highlights the importance of neurosurgical involvement and expected outcomes in managing Pancoast tumors. Given the neurosurgeon's critical role in tumor resection, further studies highlighting neurosurgical management of Pancoast tumors are warranted.

Keywords: Brachial plexus; Neurolysis; Neurosurgical management; Pancoast; Pancoast tumor; Quality of life; Spine; Superior sulcus; Tumor; Tumor resection.

FIGURE.

Preoperative view of a superior sulcus tumor. A, Tumor shows a heterogeneous hyperintense T2 signal. B, Tumor shows centrally nonenhancing areas of necrosis and partial encasement of caudal aspect of nerve root; tumor is seen abutting the vertebral bodies with no vertebral cortical destruction and anatomic abnormalities in the bone marrow spaces visualized.