RT Book, Section
A1 Urschel, Harold C.
A1 Krasna, Mark J.
A2 Sugarbaker, David J.
A2 Bueno, Raphael
A2 Colson, Yolonda L.
A2 Jaklitsch, Michael T.
A2 Krasna, Mark J.
A2 Mentzer, Steven J.
A2 Williams, Marcia
A2 Adams, Ann
SR Print(0)
ID 1105842815
T1 Pancoast Syndrome: Extended Resection in Superior Pulmonary Sulcus and Anterior Approach
T2 Adult Chest Surgery, 2e
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-178189-3
LK accesssurgery.mhmedical.com/content.aspx?aid=1105842815
RD 2024/04/19
AB Approximately  5%  of  all  non-small  cell  lung  cancers  (NSCLC)  are  located  in  the  extreme  apex  of  the  lung,  frequently  with  involvement  of  some  combination  of  the  first  and  second  ribs,  brachial  plexus,  subclavian  vessels,  and  upper  thoracic  vertebral  bodies.  This  phenomenon  is  referred  to  as  a  superior  sulcus  carcinoma,  indicating  tumor  location  in  the  uppermost  portion  of  the  costovertebral  gutter  within  the  chest.  Pancoast  syndrome  refers  to  superior  sulcus  tumors  along  with  the  triad  of  (1)  shoulder  and  arm  pain,  (2)  wasting  of  the  hand  muscles,  and  (3)  ipsilateral  Horner  syndrome  (i.e.,  ptosis,  miosis,  and  anhidrosis  due  invasion  of  the  stellate  ganglion).  Henry  Pancoast  was  a  radiologist  who  described  these  findings  in  1932  but  failed  to  recognize  the  pulmonary  origin  of  these  tumors.  Unaware  of  Pancoast  report,  Tobias,  an  Argentine  physician,  described  similar  clinical  findings  and  ascribed  them  to  the  presence  of  peripheral  lung  tumors.  Pancoast–Tobias  syndrome  is  perhaps  a  more  appropriate  eponym  for  this  entity.  Anatomically,  the  superior  pulmonary  sulcus  is  the  area  on  the  superior  surface  of  the  lung  traversed  by  the  subclavian  vessels  and  encircled  by  the  first  rib  and  spine  (Fig.  80-1).  It  also  may  be  described  as  the  thoracic  outlet  or  thoracic  inlet.