P1.14-08 The Usefulness of the Hemiclamshell Thoracotomy in Thoracic Surgery

Abstract

The antero-lateral approach provides good exposure of the cervicothoracic region and enables removal of lesions that develop in this complex anatomic area. We retrospectively evaluated the indications and outcomes of the hemiclamshell approach in patients undergoing tumor resection in thoracic surgery. Eleven lung cancer patients and one non seminomotous germ cell tumor of the mediastinum who underwent tumor resection via hemiclamshell approach in our department, between 2007 and 2018 were studied retrospectively, analyzing the indications, morbidity and outcome. The indications were apical tumors with vascular invasion in four, giant mass (10, 17, 21cm in tumor diameter) with superior or inferior vena cava invasion in three, aortic arch invasion in one, sternal invasion in one, mediastinal lymph node metastasis in the left upper lung cancer in one, and pulmonary artery aneurysm after left upper lobectomy in one. In eleven lung cancer patients, combined resection of the neighboring organ was performed in nine organs among eight patients: subclavian artery in two, carotid artery in one, aorta in one, superior vena cava in one, chest wall in two, phrenic nerve in one, and pericardium in one. One-month mortality was 0%. Operative morbidity was observed in four patients (33%): two patients suffered from deep wound infection, one from a chylothorax, and one from pleural effusion. R0 resection was achieved in eleven patients. The hemiclamshell approach was associated with relative high morbidity rate but no mortality. Hemiclamshell is suitable for tumours of the cervicothoracic junction with vascular invasion and giant tumors, providing good access for control of the large vessels including pulmonary artery and vein.