Figure 4

Step by step resection of a Pancoast tumor through an Antero-cervical approach. Incision at the anterior edge of Sterno-cleido-mastoid (a). Division of the upper sternum extended into 2^nd intercostal space(b). Mobilisation-Excision of supraclavicular fat pad (c). Exposure of the structures at the thoracic inlet by dividing the subclavius, omohyoid with preservation of the accessory nerve. Division of the Scalenus anterior with preservation of the phrenic nerve (d) & (e). Right upper Lobectomy (f): can be performed through the neck incision or a posterolateral thoracotomy.