Figure 1

The "cut-in patch-out" technique. The pleural space is initially entered in the lowest tumor free interspace typically 3 to 5 cm anterior and inferior to the tumor location, as determined by preoperative CT scan, then extended posteriorly. The anterior aspect of the chest resection was then performed 3 to 5 cm anterior to the tumor location facilitated by upward scapular retraction. A one cm segment of rib is excised anteriorly to improve chest wall mobility.