A cumurative operation for apical invading lung cancer was performed in a 49-year-old man. Left upper lobectomy was combined with resection of the chest wall, left subclavian artery and brachial nerve, following reconstruction of the left subclavian artery with an artificial vessel graft. Our approach involved sternotomy, antero-lateral thoracotomy and cutting of the clavicle. This approach is useful for apical lung cancer without wide invasion of the posterior chest wall, as in this patient. Although radiotherapy and chemotherapy were administered, the patient succumbed to hematogenous metastases 15 months after the operation. We suggest that adjuvant therapy may be needed for apical invading lung cancer, even if the tumor is believed to be completely resected.