Original Articles
Extended resections for bronchogenic carcinoma invading the superior vena cava system

https://doi.org/10.1016/S0003-4975(99)00867-XGet rights and content

Abstract

Background. Extended resection of non-small-cell lung cancer (NSCLC) involving the superior vena cava (SVC) system is infrequently performed and oncologic benefits are still uncertain.

Methods. From 1983 to 1996, 25 patients underwent resection of the SVC system for T4, NSCLC.

Results. A total of 12 pneumonectomies (48%), ten lobectomies (40%), and three wedge resections (12%) were performed. Seven patients had complete resection of the SVC with graft interposition, 12 patients underwent tangential resection of the SVC, and 1 patient had a pericardial patch; 5 patients underwent resection of right innominate and subclavian veins without vessel reconstruction. The lymph node status was N0 in 8 patients (32%), N1 in 3 (12%) and N2 in 14 patients (56%). Five patients (20%) underwent incomplete resection. Nine patients (36%) developed postoperative complications (36%) that were fatal in 3 patients (12%). At the completion of the study, 10 patients were still alive. The median survival was 11.5 months and the 5-year actuarial survival rate was 29%, with 4 patients alive at 5 years.

Conclusions. The resection of the SVC system for direct involvement by T4, NSCLC can be performed in selected patients with an acceptable postoperative mortality. Even though no significant prognostic factors were observed, the patients who required a lobectomy with limited lymph node involvement seemed to benefit the most from surgery.

Section snippets

Material and methods

From January 1983 to June 1996, 25 consecutive patients with NSCLC invading the SVC system were operated on. Only patients with direct involvement of the SVC system by the tumor were considered for surgical resection, whereas patients with SVC involvement related to bulky N2 disease were not considered for resection.

There were 22 men and 3 women with a mean age of 59 years, ranging from 36 to 77 years.

Eligibility for SVC system resection included: (1) histologically proven invasion of the SVC

Results

The follow-up was complete for all but 1 patient, who was untraceable after 6 months of follow-up.

Five patients had neoadjuvant treatment (chemotherapy in 4 patients, radiotherapy in 1 patient) while the others were operated on before any medical treatment.

Comment

Tumor involvement of the SVC system can occur either by direct extension of the primary tumor (T4) or by invasion of bulky mediastinal adenomegaly (N2) 1, 2, 4; moreover, often, bulky lung cancer involves other mediastinal structures such as carina, left atrium, or both. Thus, the unresectability of a lung cancer invading the SVC system may be technical (direct tumor invasion of other mediastinal structures) or/and oncologic due to the presence of bulky N2 disease. However, in some cases, SVC

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