T anterior cervicothoracic approach to the thorax is used for radical resection of superior sulcus tumors invading the thoracic inlet. These tumors are small sized neoplasms situated at a definite location of the thoracic inlet that evoke a characteristic clinical picture called Pancoast-Tobias syndrome.1-4 The local nerve and bone involvement produces this syndrome at an early stage of the disease, generally before the mass is well defined radiographically, and lymphatic and distant metastasis occurs.1,5 For many years, these tumors were considered inoperable, and treatment consisted of palliative radiation therapy. However, during the last few decades, it became evident that the best treatment is the combination of preoperative radiation therapy (30 Gy) followed by surgical resection.1,6-12 As reported by Shaw and colleagues, the preferred surgical procedure consists of an extended en bloc resection of the chest wall (usually including posterior portions of the first 3 ribs and the transverse processes), the intercostal nerves, the lower trunk of the brachial plexus together with the involved lung, resected usually with lobectomy or segmental resection, performed with a posterior interscapulo-vertebral approach.6 This combined treatment modality usually results in long-term survival (ie, 5-year rates approximately 30% to 34%) and cure for select patients.6-12 The presence of positive mediastinal lymph nodes and extensive vertebral body, brachial plexus, and subclavian vascular invasion represent poor prognostic factors and, thus, contraindications for surgical resection.2,7,12-14 Several years ago, we described a combined cervicothoracic approach for resection of apical lesions invading the thoracic inlet.15,16 During the course of our 15-year experience with the transclavicular approach, we have learned how to perform the entire resection with a single anterior approach, provided some modifications and improvements to our initial technique. We describe the procedure as we presently perform it routinely, including technical modifications we made to resect the upper lobe along with the invaded bony, vascular17 and soft tissues with the cervical approach alone, without complementary thoracotomy.