{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T07:54:43Z","timestamp":1773820483030,"version":"3.50.1"},"reference-count":20,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:italic>en bloc<\/jats:italic>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1729706","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T06:55:57Z","timestamp":1773816957000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Resection of the entire first rib for a malignant tumor via the transclavicular approach: a case report and literature review"],"prefix":"10.3389","volume":"13","author":[{"given":"Zhiqing","family":"Zhao","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinli","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taiqiang","family":"Yan","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Peking University First Hospital","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1136\/thx.41.7.575","article-title":"Symptomatic fibrous dysplasia of the right first rib excised via a posterolateral thoracotomy","volume":"41","author":"Payne-James","year":"1986","journal-title":"Thorax"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1025","DOI":"10.1016\/S0022-5223(19)33774-2","article-title":"Anterior transcervical-thoracic approach for radical resection of lung tumors invading the thoracic inlet","volume":"105","author":"Dartevelle","year":"1993","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/S0003-4975(96)01023-5","article-title":"Transmanubrial osteomuscular sparing approach for apical chest tumors","volume":"63","author":"Grunenwald","year":"1997","journal-title":"Ann Thorac Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/j.amjsurg.2007.01.039","article-title":"Aneurysmal bone cyst originating from the first rib","volume":"195","author":"Lee","year":"2008","journal-title":"Am J Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1055\/s-0035-1569994","article-title":"Aneurysmal bone cyst arising from the first rib: a rare cause of thoracic outlet syndrome","volume":"5","author":"Medina","year":"2016","journal-title":"Thorac Cardiovasc Surg Rep"},{"key":"B6","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1002\/1097-0347(200009)22:6%3C629::AID-HED14%3E3.0.CO;2-3","article-title":"Overcoming the transclavicular approach: the transmanubrial approach to the thoracic inlet","volume":"22","author":"Spaggiari","year":"2000","journal-title":"Head Neck"},{"key":"B7","doi-asserted-by":"publisher","first-page":"584","DOI":"10.1007\/s11748-012-0044-0","article-title":"Resection of the entire first rib for fibrous dysplasia using a combined posterior-transmanubrial approach","volume":"60","author":"Furukawa","year":"2012","journal-title":"Gen Thorac Cardiovasc Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e931796","DOI":"10.12659\/AJCR.931796","article-title":"Giant cell tumor of bone of the first rib successfully treated with combined preoperative denosumab therapy and surgery via a transmanubrial approach","volume":"22","author":"Matsunobu","year":"2021","journal-title":"Am J Case Rep"},{"key":"B9","doi-asserted-by":"publisher","first-page":"5585","DOI":"10.21037\/jtd-23-983","article-title":"Robotic-assisted wire saw resection of high-position rib tumors: a single-center experience","volume":"15","author":"Peng","year":"2023","journal-title":"J Thorac Dis"},{"key":"B10","first-page":"244","article-title":"Thoracic outlet syndrome secondary to a cavernous hemangioma of the first rib","volume":"85","author":"Buero","year":"2025","journal-title":"Medicina (B Aires)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1002\/(SICI)1097-0347(199912)21:8%3C767::AID-HED13%3E3.0.CO;2-Q","article-title":"A logical approach to the thoracic inlet: the dartevelle approach revisited","volume":"21","author":"Ducic","year":"1999","journal-title":"Head Neck"},{"key":"B12","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1016\/j.athoracsur.2005.07.001","article-title":"Results of chest wall resection and reconstruction with and without rigid prosthesis","volume":"81","author":"Weyant","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/1010-7940(94)90028-0","article-title":"Chest wall reconstruction following resection of large primary malignant tumors","volume":"8","author":"Chapelier","year":"1994","journal-title":"Eur J Cardiothorac Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1118","DOI":"10.1067\/mva.2001.112801","article-title":"Thoracic outlet syndrome caused by first rib hemangioma","volume":"33","author":"Yeow","year":"2001","journal-title":"J Vasc Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2118","DOI":"10.1016\/j.athoracsur.2007.12.045","article-title":"Aneurysmal bone cyst in the first rib","volume":"85","author":"Cheng","year":"2008","journal-title":"Ann Thorac Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1308\/003588410X12664192075459","article-title":"Resection of a chondrosarcoma arising in the right first rib: a case report","volume":"16","author":"Kitada","year":"2010","journal-title":"Ann Thorac Cardiovasc Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1016\/j.jvs.2010.09.067","article-title":"Venous thoracic outlet syndrome secondary to first rib osteochondroma in a pediatric patient","volume":"53","author":"O'Brien","year":"2011","journal-title":"J Vasc Surg"},{"key":"B18","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1016\/j.athoracsur.2011.08.021","article-title":"Thoracic outlet syndrome caused by fibrous dysplasia of the first rib","volume":"93","author":"Kemp","year":"2012","journal-title":"Ann Thorac Surg"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e14531","DOI":"10.7759\/cureus.14531","article-title":"Horner syndrome secondary to osteochondroma of the first rib: a case report","volume":"13","author":"Tvedten","year":"2021","journal-title":"Cureus"},{"key":"B20","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1186\/s13019-024-02902-9","article-title":"Resection of the entire first rib for giant osteochondroma by trans manubrial approach: a case report and review of the literature","volume":"19","author":"Chen","year":"2024","journal-title":"J Cardiothorac Surg"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1729706\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T06:55:58Z","timestamp":1773816958000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1729706\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,18]]},"references-count":20,"alternative-id":["10.3389\/fsurg.2026.1729706"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1729706","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,18]]},"article-number":"1729706"}}