Petrella Francesco, Casiraghi Monica, Bertolaccini Luca, Spaggiari Lorenzo
Division of Thoracic Surgery, IRCCS European Institute of Oncology, 20141 Milan, Italy.
Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy.
J Pers Med. 2023 Jul 21;13(7):1168. doi: 10.3390/jpm13071168.
Pancoast tumors, also defined as superior sulcus tumors, still represent a complex clinical condition requiring high technical surgical skills within more articulated multimodality treatment. The morbidity and mortality rates after Pancoast tumor treatments range from 10 to 55% and 0 to 7%, respectively, and the 5-year survival rate has significantly improved in recent years thanks to the advancement of treatments. Although a multimodality approach combining chemotherapy, radiotherapy, and surgery allows for radical resection and effective local control in the vast majority of patients, many patients cannot receive surgical resection or complete the whole programmed therapeutic regimen. Systemic relapse, particularly cerebral recurrence, still poses a significant issue in this cohort of patients. Surgical resection still plays a pivotal role within the multimodality approach. Here, we focus on surgical approaches to both anterior and posterior Pancoast tumors: the anterior transclavicular approach (Dartevelle); the anterior transmanubrial approach (Grunenwald-Spaggiari); the anterior trap-door approach (Masaoka, Nomori); the posterior approach (Shaw-Paulson); the hemiclamshell approach; and hybrid approaches. Global clinical condition, tumor histology, and long-term perspectives should always be taken into consideration when embarking on such a demanding oncologic scenario.
潘科斯特瘤，也被定义为肺上沟瘤，仍然是一种复杂的临床病症，在更为复杂的多模式治疗中需要高超的手术技巧。潘科斯特瘤治疗后的发病率和死亡率分别为10%至55%和0至7%，近年来由于治疗方法的进步，5年生存率有了显著提高。尽管化疗、放疗和手术相结合的多模式方法能使绝大多数患者实现根治性切除并有效控制局部病灶，但许多患者无法接受手术切除或完成整个预定的治疗方案。全身复发，尤其是脑转移，在这类患者中仍然是一个重大问题。手术切除在多模式治疗中仍起着关键作用。在此，我们重点关注前、后潘科斯特瘤的手术方法：前锁骨下入路（达特韦尔）；前经胸骨柄入路（格鲁嫩瓦尔德 - 斯帕贾里）；前活板门入路（正冈、野守）；后入路（肖 - 保尔森）；半蛤壳式入路；以及联合入路。在开展如此具有挑战性的肿瘤治疗方案时，应始终考虑患者的整体临床状况、肿瘤组织学类型以及长期预后。
