Ann Thorac Surg. 2013 Sep;96(3):983-9

Ann Thorac Surg. 2013 Sep;96(3):983-9. doi: 10.1016/j.athoracsur.2013.04.032. Epub 2013 Jul 11.

Subclavian artery resection and reconstruction for thoracic inlet cancer: 25 years of experience.

Lahon B, Mercier O, Fadel E, Mussot S, Fabre D, Hamdi S, Le Chevalier T, Dartevelle P.

Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Thoracic Oncology Institute, Marie Lannelongue Hospital, Le Plessis Robinson, France.

Abstract

BACKGROUND: The purpose of this study was to evaluate long-term outcomes after subclavian artery resection and reconstruction during surgery for thoracic inlet cancer through the anterior transclavicular approach.
METHODS: Between 1985 and 2011, 72 patients (51 men and 21 women; mean age, 51 years) underwent en bloc resection of thoracic inlet non-small cell lung cancer (n = 59), sarcoma (n = 10), breast carcinoma (n = 2) or thyroid carcinoma (n = 1) involving the subclavian artery. An L-shaped transclavicular cervicothoracotomy was performed, with posterolateral thoracotomy in 14 patients or a posterior midline approach in 13 patients. Resection extended to the chest wall (more than two ribs, n = 53), lung (n = 66), and spine (n = 13). Revascularization was by end-to-end anastomosis (n = 40), polytetrafluoroethylene graft interposition (n = 25), subclavian-to-common carotid artery transposition (n = 6), or grafting of the autologous superficial femoral artery in an anterolateral thigh free flap (n = 1). Complete R0 resection was achieved in 65 patients and microscopic R1 resection in 7 patients. Postoperative radiation therapy was given to 46 patients.
RESULTS: There were no cases of postoperative death, neurologic sequelae, graft infection or occlusion, or limb ischemia. Postoperative morbidity consisted of pneumonia (n = 16), phrenic nerve palsy (n = 2), recurrent nerve palsy (n = 2), bleeding (n = 3), acute pulmonary embolism (n = 1), cerebrospinal fluid leakage (n = 1), chylothorax (n = 1), and wound infection (n = 1). Five-year survival and disease-free survival rates were 28% and 20%, respectively. Long-term survival was not observed after R1 resection.
CONCLUSIONS: Subclavian arteries invaded by thoracic inlet malignancies can be safely resected and reconstructed through the anterior transclavicular approach, with good long-term survival provided complete R0 resection is achieved.

PMID:23849837