PubMed TOS surgery: long-term functional results
 

I came across this it may have been posted before since date is 2004- but I don't remember seeing it.

So many ask about surgery and results I thought it would be good to post it.


1: Ann Vasc Surg. 2004 Sep;18(5):558-65. Epub 2004 Aug 6. Related Articles, Links

Thoracic outlet syndrome surgery: long-term functional results.

Degeorges R, Reynaud C, Becquemin JP.

Department of Vascular Surgery, Henri Mondor Hospital, Creteil, France. renaud.degeorges@libertysurf.fr.

The treatment of thoracic outlet syndrome (TOS) is controversial and long-term results are poorly documented. This retrospective study was carried out to assess clinical outcome 2 years after TOS surgery and to determine predictive factors of outcome.

Between 1979 and 1999, 155 patients underwent TOS surgery. Of these patients, 140 (90.3%) had a minimum follow-up of 2 years. Thirty-six (25.7%) patients underwent bilateral procedures. A total of 176 procedures were reviewed and served as a basis for study.

Presenting symptoms were neurologic in 15 cases (8.5%), arm or hand ischemia occurred in 38 cases (21.6%), and venous compression or thrombosis in 27 cases (15.4%). In 96 cases (54.5%), symptoms were mixed.

A transaxillary approach (107 cases) was chosen to address venous symptoms and minor arterial dysfunction. A supraclavicular approach (69 cases) was used when there were large abnormal bony structures, neurologic symptoms, and/or severe limb ischemia. The first rib was resected either extensively from its neck to the sternal attachment (54 cases) or partially, including the mid-rib and neck or the mid-rib and sternal attachment (121 cases), depending on symptoms, approach, and surgeon's choice. Whenever present, cervical ribs, anterior scalenus muscle, and various fibrous or muscular compressive structures were also removed.

The 2-year functional outcome according to Derkash's classification was assessed by means of a phone survey. Pre-, per-, and immediate postoperative data were recorded and compared to functional outcomes. Mean follow-up was 7.5 A+/- 3.4 years (2a<euro>"19 years).

Functional results were
excellent, 87 (49.4%)
good, 61 (34.6%)
fair, 14 (8%),
and poor in 14 (8%) procedures respectively.

Predictive factors of negative outcomes were acute ischemia ( p < 0.01), sensory or motor deficit ( p < 0.01), and poorly systematized neurological symptoms as presenting symptoms ( p < 0.05), and extended resection of the first rib ( p < 0.01) and severe postoperative complications ( p < 0.01).
This series showed that the 2-year results of TOS surgery were satisfactory in the majority of cases.
Patients suffering from poorly systematized neurological symptoms in the arm had poor results. This subset of patients should be denied surgery or at least informed that postoperative results might be disappointing.

Partial first-rib resection and a careful technique avoiding postoperative complications were also factors in long-term success.

PMID: 15534735 [PubMed - indexed for MEDLINE]

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

More links to various TOS Surgical Therapy
 

http://www.medifocushealth.com/RT017...al-Therapy.php


1. Thoracic outlet syndrome: pattern of clinical success after operative decompression.
http://www.medifocus.com/abstracts.p...17&ID=16012461
Author
Altobelli, Grant G; Kudo, Toshifumi; Haas, Bradley T; Chandra, Fiona A; Moy JL; Ahn SS; Altobelli GG; Kudo T; Haas BT; Chandra FA; Moy JL; Ahn SS; Altobelli GG; Kudo T; Haas BT; Chandra FA; Moy JL; Ahn SS;
Institution
Gonda (Goldschmied) Vascular Center, University of California at Los Angeles, 90095, USA.
Journal
J Vasc Surg. 2005 Jul;42(1):122-8.

2. Neurogenic thoracic outlet syndromes: a comparison of true and nonspecific syndromes after surgical treatment.
http://www.medifocus.com/abstracts.p...17&ID=16488246
Author
Colli BO; Carlotti CG Jr; Assirati JA Jr; Marques W Jr; Colli BO; Carlotti CG Jr; Assirati JA Jr; Marques W Jr; Colli BO; Carlotti CG Jr; Assirati JA Jr; Marques W Jr; Colli BO; Carlotti CG Jr; Assirati JA Jr; Marques W Jr;
Institution
Division of Neurosurgery, Department of Surgery, Hospital das Clinicas, Ribeirao Preto Medical School, University of Sao Paulo, Brazil. bocolli@fmrp.usp.br
Journal
Surg Neurol. 2006 Mar;65(3):262-71; discussion 271-2.

3. Doppler Adson's test: predictor of outcome of surgery in non-specific thoracic outlet syndrome.
http://www.medifocus.com/abstracts.p...17&ID=16479352
Author
Lee AD; Agarwal S; Sadhu D; Lee AD; Agarwal S; Sadhu D;
Institution
Department of General Surgery, Christian Medical College, Vellore, India. arvindlee@yahoo.com
Journal
World J Surg. 2006 Mar;30(3):291-2.

4. Computer-assisted instrumentation during endoscopic transaxillary first rib resection for thoracic outlet syndrome: a safe alternate approach.
http://www.medifocus.com/abstracts.p...17&ID=16390650
Author
Martinez BD; Wiegand CS; Evans P; Gerhardinger A; Mendez J; Martinez BD; Wiegand CS; Evans P; Gerhardinger A; Mendez J;
Institution
Minimally Invasive Vascular Surgery Department, St. Vincent Mercy Medical Center, Toledo, Ohio, USA.
Journal
Vascular. 2005 Nov-Dec;13(6):327-35.

5. Thoracic outlet decompression for subclavian vein thrombosis: experience in 71 patients.
http://www.medifocus.com/abstracts.p...17&ID=15655206
Author
Divi, Vasu; Proctor, Mary C; Axelrod, David A; Greenfield, Lazar J; Divi V; Proctor MC; Axelrod DA; Greenfield LJ;
Institution
Department of Surgery, University of Michigan, Ann Arbor 48105, USA.
Journal
Arch Surg. 2005 Jan;140(1):54-7.

6. Thoracic outlet syndrome surgery: long-term functional results.
first post on this thread is this results article.
Author
Degeorges R; Reynaud C; Becquemin JP;
Institution
Department of Vascular Surgery, Henri Mondor Hospital, Creteil, France. renaud.degeorges@libertysurf.fr.
Journal
Ann Vasc Surg. 2004 Sep;18(5):558-65. Epub 2004 Aug 6.

7. Clinical predictors of surgical outcome in patients with thoracic outlet syndrome operated on via transaxillary approach.
http://www.medifocus.com/abstracts.p...17&ID=14747108
Author
Yavuzer S; Atinkaya C; Tokat O;
Institution
Department of Thoracic Surgery, Ankara University Faculty of Medicine, Ibn-i Sina Hospital, 06100, Sihhiye, Ankara, Turkey. yavuzers@hotmail.com
Journal
Eur J Cardiothorac Surg. 2004 Feb;25(2):173-8.

8. Combined surgical treatment of thoracic outlet syndrome: transaxillary first rib resection and transcervical scalenectomy.
http://www.medifocus.com/abstracts.p...17&ID=15005387
Author
Atasoy E;
Institution
Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA. bstewart@kleinertkurtz.com
Journal
Hand Clin. 2004 Feb;20(1):71-82, vii.

9. Surgical management of thoracic outlet syndrome: a 10-year experience.
http://www.medifocus.com/abstracts.p...17&ID=15191480
Author
Samarasam I; Sadhu D; Agarwal S; Nayak S;
Institution
Department of Surgery, Christian Medical College and Hospital, Vellore, Tamilnadu, India. inians@cmcvellore.ac.in
Journal
ANZ J Surg. 2004 Jun;74(6):450-4.

10. Epineurectomy for thoracic outlet syndrome.
http://www.medifocus.com/abstracts.p...17&ID=15005388
Author
Wehbe MA; Whitaker ML;
Institution
Department of Orthopaedic Surgery, Jefferson Medical College, Philadelphia, PA, USA. marwan.wehbe@pahandcenter.com
Journal
Hand Clin. 2004 Feb;20(1):83-6.


the home page for all of this info-
http://www.medifocushealth.com/RT017/index.php

I would just point out to be wary of studies done in less developed countries.
India, Brazil, Turkey...how advanced are their medical systems? Just a note to consider...I haven't looked at them yet.

Also, look at the journal. A good journal will take a submitted paper and send it to qualified peers in the field for review and comments. This helps to get a reliable and well constructed paper into the journal. Some are better reviewed than others...J of Vascular Surgery- Probably pretty reliable. Others? World J of Surg? Ever heard of that one? Who knows if someone really reviewed that articla before publication.


Defeinitely interested inthe UCLA article.

Bump up for members looking for surgery results.

I also added a 2009 results study to our useful sticky thread.
here-
http://neurotalk.psychcentral.com/sh...901#post777901

and you might as well read about pec minor syndrome and tenotomy info

here is one thread and I'm sure a search will bring up more discussions on the forums -
http://neurotalk.psychcentral.com/sh...ad.php?t=29324