2．選択術式：導入療法後transmanubrial approach に 後方アプローチを加えて切除したPancoast 型肺癌

A 59-year old man complaining of right shoulder pain was diagnosed with Pancoast tumor. Chestcomputed tomography （CT） scan showed a right superior sulcus tumor, 5.8 cm in diameter, invadingthe middle-posterior compartment of thoracic inlet. Chest magnetic resonance imaging （MRI） sagittalsection showed the possibility of infiltration to subclavian artery. The patient received preoperativeconcurrent chemoradiotyrapy （CCRT） ［radiotherapy：60 Gy/30 Fr, cisplatin and docetaxel］, resultingin tumor regression （PR）. The patient underwent right upper lobectomy and resection of the 1st- 2ndribs and Th1 nerve via transmanubrial approach and high posterior thoracotomy.Pathological examination demonstrated a little live cancer cells and organization of necrotic tissue inthe lung and inter costal region （Ef.2）. Transmanubrial osteomuscular sparing technique maintains anexcellent exposure of thoracic inlet and cervical structures safely.