Superior Sulcus Lung Cancer Invading the Ribs and Brachial Plexus Successfully Resected by Modified Trap-door Thoracotomy after Induction Chemoradiotherapy

We report on a 49-year-old male patient presented with right superior sulcus lung adenocarcinoma, which had invaded the first and second ribs and brachial plexus. He underwent concurrent chemoradiotherapy, which resulted in a partial response. The tumor was resected along with the first and second ribs without difficulty via a modified trap-door thoracotomy. The brachial plexus was preserved, and the surgical margin was microscopically negative for cancer due to the effect of the neoadjuvant chemoradiotherapy which degenerated most of the tumor into scar tissue. We conclude that modified trap-door thoracotomy is a good approach for resection of superior sulcus lung cancer invasive to the first and second ribs and brachial plexus. Neoadjuvant chemoradiotherapy is also necessary to achieve a negative surgical margin.