**11. Conclusion**

Pancoast tumours represent a small percentage of Lung cancer population (1-5%). Due to poor performance status and/or advanced tumour stages, only 30-40 % [10, 13] of those patients are eligible to be enrolled in multi-modality protocols of treatment.

Careful patient selection and adherence to protocols enables Clinical groups to get an impres‐ sion of the efficacy of an intervention and to compare results between studies.

Superior sulcus tumours remain an extremely severe condition, but cure may be achieved in a large percentage of cases. The surgical approach should be adapted to the different clinical and radiologic presentations in order to achieve a complete surgical resection, which repre‐ sents the most important positive prognostic factor. Surgery carries a high operative risk, especially if a combined approach is needed, so every effort should be made to identify patients expected to derive a benefit that outweighs risks.

No single surgical approach however, provides the best access to all of the heterogeneous tumours of the thoracic inlet. The thoracic surgeon must be familiar with the potential advantages that the anterior approach offers under given circumstances. This knowledge enables the thoracic surgeon to explore new avenues and exciting challenges. Dartevilles approach and the various modifications are technically demanding, however once the anatomy has been appreciated, direct visualisation of the major structures of the Thoracic inlet aids to facilitate complete oncological clearance. Whether the anterior approach results in less loco-regional recurrences and possibly better 5 year survival, remains to be seen.
