Korst R J, Burt M E
Thoracic Service, The Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
J Thorac Cardiovasc Surg. 1998 Feb;115(2):286-94; discussion 294-5. doi: 10.1016/S0022-5223(98)70271-5.
Our goal was to describe the "hemi-clamshell" approach for the resection of primary and metastatic tumors of the cervicothoracic junction, evaluate its morbidity and mortality, and present survival data on a series of 42 patients who underwent resection with the use of this technique.
We conducted a retrospective review of the records of all patients of a single surgeon undergoing resection of tumors of the cervicothoracic junction. Data collected includes tumor type and involvement, type of resection, complications, and survival.
Forty-two patients underwent resection of various primary (n = 28) and metastatic (n = 14) tumors of the cervicothoracic junction over 6.5 years by means of the hemi-clamshell approach. En bloc resection of the tumor and invaded structures was successful in all but two patients (5%), who required an additional posterolateral thoracotomy to facilitate removal of tumor invading the posterior chest wall. Invaded structures that were resected included lung (n = 22), vertebral body (n = 7), chest wall (n = 8), central veins (n = 10), thyroid (n = 3), carotid artery (n = 1), and cervical esophagus (n = 1). Four major complications occurred in three patients, and nine minor complications occurred in eight patients. There were no deaths. The overall 5-year actuarial survival was 67.4%.
Tumors of the cervicothoracic junction are represented by a variety of histologic types and can be both primary and metastatic. The hemi-clamshell approach is a successful technique for the exposure and resection of these tumors. This approach has significant advantages over other previously reported techniques. The complication rate is low and the mortality rate is zero in this series, the largest yet reported. Long-term survival is acceptable if complete resection can be performed.
我们的目标是描述用于切除颈胸交界区原发性和转移性肿瘤的“半蛤壳式”手术方法，评估其发病率和死亡率，并给出42例采用该技术进行手术切除患者的生存数据。
我们对一位外科医生为所有颈胸交界区肿瘤患者进行手术切除的记录进行了回顾性研究。收集的数据包括肿瘤类型及累及情况、手术切除类型、并发症和生存率。
在6.5年期间，42例患者通过半蛤壳式手术方法接受了颈胸交界区各种原发性（n = 28）和转移性（n = 14）肿瘤的切除。除2例患者（5%）外，其余患者均成功整块切除肿瘤及受侵结构，这2例患者需要额外行后外侧开胸手术以利于切除侵犯后胸壁的肿瘤。被切除的受侵结构包括肺（n = 22）、椎体（n = 7）、胸壁（n = 8）、中心静脉（n = 10）、甲状腺（n = 3）、颈动脉（n = 1）和颈段食管（n = 1）。3例患者出现4例严重并发症，8例患者出现9例轻微并发症。无死亡病例。总体5年精算生存率为67.4%。
颈胸交界区肿瘤组织学类型多样，可为原发性或转移性。半蛤壳式手术方法是暴露和切除这些肿瘤的成功技术。该方法比其他先前报道的技术具有显著优势。本系列是迄今报道的最大系列，并发症发生率低，死亡率为零。如果能进行完整切除，长期生存率是可以接受的。
