Kraus D H, Huo J, Burt M
Department of Surgery (Head and Neck and Thoracic Services), Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
Head Neck. 1995 Mar-Apr;17(2):131-6. doi: 10.1002/hed.2880170210.
Surgical resection of tumors of the cervicothoracic junction is often problematic due to the limitations imposed by the thoracic cage and adjacent neurovascular structures. The majority of surgical approaches to this region have been designed with the intent of providing adequate exposure for vertebrectomy with tumor resection and vertebral column stabilization. These approaches do not provide adequate exposure for a heterogeneous group of tumors which also involve the cervicothoracic junction. We used a combined cervicothoracic surgical approach to determine its efficacy in tumor resection.
Seventeen patients with a heterogeneous group of malignancies arising in a variety of soft tissues underwent combined cervicothoracic resection. The approach consisted of anterior cervical access, median sternotomy, and anterior thoracotomy.
Complete gross tumor resection was accomplished in all 17 patients, 15 of whom had negative microscopic margins. Extensive reconstruction was employed in 6 patients. Three patients received intraoperative brachytherapy implants and 5 patients received external-beam postoperative radiotherapy. Local tumor control was obtained in 12 patients, and 10 patients are currently alive, free of disease (median: 12 months; range: 3-47 months). There was no inadvertent sacrifice of neurovascular structures. The sternoclavicular joint was maintained in all patients. There were 4 major complications, and no perioperative mortality associated with the surgical procedure.
The combined "trap door" technique provides sufficient exposure for resection of cervicothoracic tumors. Surgery is performed with limited morbidity with the sparing of uninvolved neurovascular structures. The sterno-clavicular joint was maintained in all patients. Preliminary results using this approach for resections of tumors of the cervicothoracic junction are encouraging.
由于胸廓和相邻神经血管结构的限制，颈胸交界区肿瘤的手术切除常常存在问题。该区域的大多数手术入路设计目的是为椎体切除、肿瘤切除及脊柱稳定提供充分暴露。但这些入路对于同样累及颈胸交界区的异质性肿瘤组无法提供充分暴露。我们采用颈胸联合手术入路来确定其在肿瘤切除中的疗效。
17例各种软组织发生异质性恶性肿瘤的患者接受了颈胸联合切除术。该入路由颈前入路、正中胸骨切开术和前胸壁切开术组成。
17例患者均实现了肿瘤大体完全切除，其中15例显微镜下切缘阴性。6例患者进行了广泛重建。3例患者术中植入近距离放射治疗装置，5例患者术后接受外照射放疗。12例患者实现了局部肿瘤控制，10例患者目前存活且无疾病（中位数：12个月；范围：3 - 47个月）。未发生意外的神经血管结构损伤。所有患者的胸锁关节均得以保留。发生4例严重并发症，未发生与手术相关的围手术期死亡。
联合“活板门”技术为颈胸肿瘤切除提供了充分暴露。手术的发病率有限，未受累的神经血管结构得以保留。所有患者的胸锁关节均得以保留。使用该入路切除颈胸交界区肿瘤的初步结果令人鼓舞。
