259 The Neurosurgical Management of Pancoast Tumors: Evolution of Perioperative Management, Operative Techniques, and Literature Review

INTRODUCTION: Pancoast tumors (superior sulcus or apical lung tumors) require a multidisciplinary approach often involve both thoracic and neurosurgical teams. Neurosurgeons play a pivotal role during tumor resection, due to the tumor’s proximity to the spinal cord and brachial plexus. While well-studied in the thoracic surgery literature, limited studies exist from a neurosurgical perspective. Radical resection is often selected to ensure complete removal. However, this can impair motor and sensory function in the affected upper extremity, detrimentally impacting patients’ quality of life (QoL) and overall survival. METHODS: Patients at an NCI-designated institute were prospectively enrolled in an IRB-approved surgical database. Those patients surgically treated for Pancoast tumors were identified. Patient demographics, tumor characteristics, preoperative and postoperative measurements, discharge disposition, and follow-up were collected. Basic descriptive statistics and p-values were performed. RESULTS: Nineteen patients were included. Mean age was 59+7.88 years. 42.11%(n=8) were female. 43.75% (n=7) were staged as T3 and 56.25% (n=9) as T4. 89.47% (n=17) had preoperative chemoradiotherapy. 89.47% (n=17) and 21.05% ( n=4) presented with upper extremity pain and paresthesia, respectively. 57.89% (n=11) presented with respiratory symptoms. Mean time from diagnosis to surgery was 143.53+39.87 days. 100% underwent resection of apical tumor and chest wall, with complete removal achieved in 89.47% (n=17). 26.32% (n=5) experienced major complications; two developed sepsis and three required revision surgery. Average follow-up was 3.30+2.64 years. 15.79% (n=3) had tumor recurrence. 26.32% (n=5) were deceased at an average 19.80+13.80 months. CONCLUSIONS: Our case series highlights the importance of neurosurgical involvement and expected outcomes in managing Pancoast tumors. Given the neurosurgeon’s critical role in tumor resection, further studies highlighting the neurosurgical management of Pancoast tumors are warranted.