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 2024/10/14 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.