Complete First Rib Resection for Malignant Tumor via Transclavicular Approach

Overview

This case study reports successful en bloc resection of a malignant first rib tumor using a transclavicular approach, enabling excellent exposure and neurovascular protection. The patient experienced complete symptom resolution and preserved neurological function postoperatively.

Background

Malignant tumors of the first rib are extremely rare and pose significant surgical challenges due to the rib's proximity to vital neurovascular structures such as the subclavian vessels and brachial plexus. The clavicle overlies the first rib, complicating access and limiting exposure. Various surgical approaches exist, but no standardized technique has been established. The transclavicular approach involves clavicular osteotomy and reconstruction, providing direct visualization and facilitating safe tumor resection.

Data Highlights

Imaging revealed an osteolytic lesion with pathological fracture in the right first rib, with a PET-CT SUVmax of 11.1 indicating malignancy. A 12-cm supraclavicular incision and V-shaped clavicular osteotomy allowed complete first rib resection. Postoperative recovery was uneventful, with chest tube removal on day 3 and discharge on day 10. At 3 months, the patient had full shoulder function and no neurological deficits.

Key Findings

• The transclavicular approach provides excellent exposure for complete first rib tumor resection.
• Clavicular osteotomy and anatomical reconstruction with a locking plate enable safe access and preserve shoulder girdle stability.
• Meticulous dissection and protection of the subclavian vessels, brachial plexus, and phrenic nerve are critical to avoid complications.
• En bloc resection of the first rib with tumor was achieved without neurological deficits or vascular injury.
• Postoperative outcomes included resolution of pain, intact neurological function, and satisfactory cosmetic results.

Clinical Implications

The transclavicular approach should be considered a valuable surgical option for malignant tumors of the first rib, especially when lesions are adjacent to critical neurovascular structures. This technique allows safe tumor removal with direct visualization and protection of vital anatomy, while enabling clavicular reconstruction to maintain shoulder function. Surgeons must carefully plan and execute clavicular osteotomy and neurovascular dissection to optimize outcomes.

Conclusion

The transclavicular approach facilitates safe and complete resection of malignant first rib tumors with excellent exposure and neurovascular preservation. This technique offers a reproducible and effective surgical option for these rare and challenging lesions.

References

1. Complete Resection of the First Rib for Malignant Tumor Using a Transclavicular Technique: A Case Study and Review of the Literature