Transmanubrial osteomuscular sparing approach for resection of cervico-thoracic lesions.

BACKGROUND: To review our experience of transmanubrial osteomuscular sparing approach (TMA) for resection of various lesions involving the thoracic inlet and to prove the feasibility and safety of the approach.

METHODS: Retrospective review of 58 consecutive cases, from April 2007 to January 2016, with surgical resection of cervico-thoracic lesions via TMA.

RESULTS: There were 22 neurogenic tumors, 21 bronchogenic tumors, and 15 other cases in the study. There was no intraoperative or postoperative mortality. Mean postoperative stay was 10.5 days (3-33 days). Mean operation time was 179.0 mins (57-328 mins) and the mean volume of blood loss for bronchogenic tumors was 900 mL, which was similar to non-bronchogenic tumors (474 mL, P=0.103). Moreover, patients with malignant tumors had more intraoperative blood loss than patients with benign diseases did (847 versus 194 mL, P=0.001). R0 resection was achieved in 28 of 33 (84.8%) malignant cases. Tumor size was related to incomplete resection (8.19 vs . 5.72 cm, P=0.023) in malignancy. Five (8.6%) cases were complicated with chylothorax and all occurred in patients with left incision. All of 21 cases (100%) with brachial plexus compression symptom were relieved after surgery and 3 of 4 (75%) cases with Horner's syndrome were ameliorated postoperatively.

CONCLUSIONS: TMA can be carried out safely in treating various cervico-thoracic lesions with good resection rate. Left side procedure should be cautious of thoracic duct injury.