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Ann Thorac Surg 2003;75:634
© 2003 The Society of Thoracic Surgeons

Correspondence

Anterior approach versus posterior approach in apical chest tumor: surgeon’s choice or oncological need?: Reply

Emmanuel Martinod, MDa, Jacques F. Azorin, MDa

a Service de Chirurgie Thoracique et Vasculaire, Hôpital Avicenne, 125, route de Stalingrad, 93000 Bobigny, France

e-mail: emartinod{at}wanadoo.fr

To the Editor:

We agree with the anatomical classification used by Dr Spaggiari that divides apical chest tumors into three subtypes and its implication in the choice between the anterior and the posterior approach. Our study [1] clearly showed that the posterior thoracotomy popularized by Shaw and associates [2] in 1961 remains the standard surgical approach for the resection of superior sulcus tumors. However, as we emphasized in the Comment section of our article [1], we believe that the choice of thoracic approach for these tumors should be individualized and should not simply adhere to dogma. Schematically, apical chest tumors without marked invasion of the thoracic inlet should be resected through a posterior approach. For the others, an anterior approach should be proposed and then if necessary, combined with a posterior approach to complete the resection. The high incidence (22.3%) of wedge resections in our study, which included seven thoracic surgical centers, seems to be the direct consequence of the number of resections performed through an anterior approach. Standardized surgical treatment of lung cancer consists of a formal anatomical resection such as lobectomy. Therefore, it is surprising that this surgical dogma is not routinely applied to apical chest tumors. In the case of resection using an anterior approach, a combined posterior thoracotomy is recommended to provide a standard lobectomy with complete lymph node dissection.

References

  1. Martinod E., D’Audiffret A., Thomas P., et al. Management of superior sulcus tumors: experience with 139 cases treated by surgical resection. Ann Thorac Surg 2002;73:1534-1540.
  2. Shaw R.R., Paulson D.L., Kee J.L. Treatment of the superior sulcus tumor by irradiation followed by resection. Ann Surg 1961;154:29-21240.




This Article
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