Long-term outcome over a decade after first rib resection for neurogenic thoracic outlet syndrome.

OBJECTIVES: The aim was to determine long-term outcomes over a decade after first rib resection (FRR) in patients with neurogenic thoracic outlet syndrome (NTOS). A secondary aim was to investigate correlation of residual rib stump with long-term symptoms. METHODS: This ambispective cohort included patients who underwent transaxillary FRRs for NTOS between 1998 and 2007. Short-term outcomes at 3-month clinical follow-up were retrospectively collected from medical records. Patients who agreed to participate in the study were invited to a long-term clinical follow-up in 2019. Disabilities of Arm, Shoulder, and Hand Score and Cervical Brachial Symptom Questionnaire were used. A chest X-ray limited to a clavicular projection was taken, and the length of the residual first rib was measured. RESULTS: Twenty patients {mean age 41.8 [standard deviation (SD): 10.3 years]} who underwent 27 FRRs participated in the study. The mean follow-up time was 14.9 (SD: 3.6) years. Excellent or good recovery was noted after 16 (59.3% of operated arms) operations in the short-term follow-up and 22 (81.5%) operations in the long-term follow-up. No reoperations were necessary for residual symptoms. The mean Cervical Brachial Symptom Questionnaire score was 26.7 (SD: 28.2) (maximum 120), and the Disabilities of Arm, Shoulder, and Hand Score was 21.1 (SD: 18.4) (maximum 100) points. Twenty-six patients (96.3%) had a noticeable residual first rib stump. The mean length of the residual first rib was 28.9 (SD: 9.5) mm. More than 30-mm rib stump did not indicate a worse long-term outcome. CONCLUSIONS: This study showed good long-term outcome without symptom recurrence after FRR for NTOS. In most patients, after surgery, quality of life and ability to work improved. Residual rib stump length was not associated with the treatment outcome.

Thoracoscopic Versus Transaxillary Approach to First Rib Resection in Thoracic Outlet Syndrome.

BACKGROUND: This study assessed the feasibility of fully endoscopic thoracoscopic first rib resection (FRR) in the treatment of neurogenic thoracic outlet syndrome by comparing early outcomes of the thoracoscopic technique against the traditional transaxillary FRR. METHODS: Between 2009 and 2016, 60 consecutive FRRs were performed on 47 patients with neurogenic thoracic outlet syndrome (13 bilateral procedures). The first 30 procedures were performed using the traditional transaxillary technique, and the novel thoracoscopic technique was used in the next 30 operations with the same indications for operative repair. All data were collected retrospectively by independent investigators. The main issues were operation time, learning curve, hospital length of stay, complications, and clinical follow-up status at 3 months. RESULTS: The groups were similar at baseline. The mean operation time was 83 ± 27 minutes in the thoracoscopic group and 48 ± 12 minutes in the transaxillary group (p < 0.001). The first thoracoscopic procedures were 2 hours long, after which, a steady 1-hour procedure time was achieved. Differences regarding the hospital stay or the need for postoperative pain medication were not significant. Two-thirds reported good or excellent recovery at follow-up in both groups. There were no immediate complications. Plexus neuralgia developed in 1 patient 3 weeks after the thoracoscopic operation, and 3 patients were diagnosed with superficial wound infection after the transaxillary procedure. CONCLUSIONS: This study showed that FRR for neurogenic thoracic outlet syndrome can be done safely with a fully endoscopic approach. However, the technique requires experience with thoracoscopic surgery, and there is a learning curve to the procedure.