Surgical therapy for apical invasive lung cancer: different approaches according to tumor location.

Thirty-one patients with apical invasive lung cancer were reviewed. The tumor occupied the anterior portion of the lung apex in four, the middle portion in one, the posterior portion in 17, and the entire apex in nine. Nine patients were treated by irradiation alone. Twenty-two patients underwent en bloc resection of the apical chest wall and the lung. Seventeen patients were operated on by different approaches: anterior and hook, according to the location of the lesion. Nine patients were operated on by the anterior approach and eight by the hook approach. Another five patients were operated on by the conventional postero-lateral approach. Lesions of the sternum and subclavian vessels and ipsilateral supraclavicular lymph nodes were resected by the anterior approach. Lesions of the vertebrae, brachial plexus, subclavian vessels and ipsilateral supraclavicular lymph nodes could be resected by the hook approach. The anterior approach was suited for lesions in the anterior portion or middle portion and the hook approach for lesions in the middle or posterior.