The surgical management of Pancoast-Tobias tumors is hard and complex due to their particular anatomical location especially the proximity of vascular and nerve structures. Like any other oncological surgery, the surgical management of Pancoast-Tobias tumors must be complete by resecting the entire tumor with safe margins. It has been demonstrated that in terms of survival, the incomplete resection is a negative prognostic factor. Currently, the ideal treatment is lobectomy combined with radical lymphadenectomy, in order to lower local recurrence and to improve survival. However, the easy and simultaneous access to axillar, cervical and mediastinothoracic regions where Pancoast-Tobias tumors develop, is not possible with any surgical technic. The anterior cervicothoracic approaches allow better exposure of the lung apex and lower cervical anatomical structures.