Thoracic Outlet Syndrome Surgery: Long-Term Functional Results

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 ± 3.4 years (2–19 years). Functional results were excellent, good, fair, and poor in 87 (49.4%), 61 (34.6%), 14 (8%),and 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.