Modified Anterolateral Approach Provides Improved Accessibility to the Lung Hilum Vascular Region for Giant Mass Lung Cancer Pneumonectomy

Abstract

Surgical management of patients with a huge pulmonary mass remains a challenge. The surgical risk is amplified by potential hemorrhage, problematic surgical exposure, difficult handling of the tumor, and poor vascular control. We describe a technique that uses a modified anterolateral thoracotomy to accomplish pneumonectomy. An anterolateral thoracotomy was entered through the 4th or 5th intercostal space. The intercostal muscles of the involved interspace were dissected off long enough but without dividing the overlying chest wall muscles. This crucial maneuver allowed a wide rage of rib spreading. The pulmonary hila and lateral aspect of the mediastinum were thus best exposed. Seven patients with large mass pulmonary cancer were admitted for surgical resection via this approach. Intrapericardial access to pulmonary vessels was obtained for pneumonectomy in all patients, including combined carinoplasty and superior vena cava reconstruction for one case. The perioperative courses were smooth and R0-resection was achieved in all cases. The modified anterolateral approach permits very good exposure and control of the pulmonary vessels at the hilum, enabling the resection maneuver to be effective, quick, and safe.