Resection of the entire first rib for a malignant tumor via the transclavicular approach: a case report and literature review.

[BACKGROUND] Malignant tumors of the first rib are extremely rare. Resection of the entire first rib is surgically challenging and requires an ingenious approach due to the complex anatomical characteristics. Currently, there is no standardized surgical approach. We herein report a case requiring resection of the entire first rib for a malignant tumor via the transclavicular approach and review relevant literature.

[CASE PRESENTATION] A 43-year-old Chinese male suffered from right-sided neck and back pain for 1 month. Imaging studies (chest computed tomography, magnetic resonance imaging, and positron emission tomography-computed tomography) revealed an osteolytic lesion with pathological fracture in the right first rib, suggestive of malignancy. Due to the lesion's proximity to critical neurovascular structures, percutaneous biopsy was not feasible. The patient underwent resection of the entire first rib via the transclavicular approach, which included a V-shaped clavicular osteotomy for exposure, meticulous mobilization and protection of the subclavian vessels and brachial plexus, and subsequent anatomical clavicular reconstruction with a locking plate. The postoperative course was uneventful, with resolution of symptoms and no neurological deficits. Histopathology confirmed lymphoma.

[CONCLUSIONS] The transclavicular approach provides excellent exposure for the safe and complete resection of first rib tumors, facilitating neurovascular protection and direct visualization. This technique offers a valuable surgical option for selected tumors in this challenging location.