Resection of superior sulcus carcinomas (anterior approach).

Physicians' understanding of the anatomy, biology [9], and treatment outcome [12] for superior sulcus carcinoma has changed greatly during the last decade [2,3]. One of the major advances in this regard has been the introduction of anterior approaches for resection. These approaches increase the likelihood of complete resection and permit resection of tumors that were previously considered technically unresectable. Each approach must be understood in detail to avoid incomplete operations and life-threatening complications. These technical advances, with recent evidence that preoperative chemoradiotherapy leads to higher complete resection rates, overall survival, and local control than do radiation and surgery alone [32], have changed physicians' attitudes toward superior sulcus carcinomas, especially for those tumors (eg, T4) previously considered technically unresectable and oncologically incurable. It is hoped that, in the future, resection of disease invasion of the brachial plexus above C7 will be technically feasible [33], and that new drugs will reduce the risk of systemic relapse after resection.