Clinical application of Grunenwald incision in cervicothoracic junction surgery.

Background: To evaluate the clinical efficacy of Grunenwald incision in cervicothoracic junction surgery.

Methods: A retrospective analysis was performed on 29 patients treated at the Fourth Hospital of Hebei Medical University, including 28 patients with cervicothoracic junction tumors (11cases of upper mediastinal tumors, 7 cases of superior sulcus tumors, 4 cases of thyroid tumors with upper mediastinal invasion, 4 cases of chest wall tumors, 2 cases of esophageal cancers with supraclavicular lymph node metastasis) and 1 patient with cervicothoracic junction penetrating trauma. Grunenwald incision or additional posterolateral thoracic incision, median sternal incision or neck collar incision were used in all patients.

Results: There was no perioperative death in the whole group. Complete tumor resection was achieved in 25 cases; palliative resection was performed in three cases, and one case underwent complete foreign body removal. The operation time ranged from 120 to 430 minutes, with an average of (231.90 ± 85.30) minutes. The intraoperative blood loss was between 100 and 1000 milliliters, with an average of (286.56 ± 192.90) milliliters. The postoperative hospital stay lasted 6 to 28 days, with an average of (13.14 ± 5.12) days. Follow-up periods spanned 6 to 142 months, with an average of (66.66 ± 46.96) months. During the follow-up period, six patients died.

Conclusions: Grunenwald incision can provide good exposure of the structures near the cervicothoracic junction, preserve the integrity of the sternoclavicular joint, reduce shoulder deformity, and has advantages for patients with cervicothoracic junction tumor, high rib resection, and cervicothoracic junction trauma.