Original article
Cardiovascular
Superior Vena Cava Resection for Lung and Mediastinal Malignancies: A Single-Center Experience With 70 Cases

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.
https://doi.org/10.1016/j.athoracsur.2006.07.075Get rights and content

Background

The oncologic value of superior vena cava (SVC) resection for lung and mediastinal malignancies remains controversial. In this context, we have reviewed our experience in the treatment of locally advanced lung and mediastinal tumor invading the SVC system, analyzing postoperative outcome and long-term oncologic results.

Methods

The clinical data of patients who underwent SVC resection were retrospectively analyzed to assess postoperative mortality, and overall and procedure-specific morbidity. Overall survival was calculated for mediastinal and lung tumor groups.

Results

From 1998 to 2004, 70 consecutive patients (52 with lung cancer and 18 with mediastinal tumors) underwent SVC system resection. There were 25 replacements (36%) of the SVC system by prosthesis, whereas the remaining underwent partial resection. Major postoperative morbidity and mortality rates in lung cancer patients were 23% and 7.7%, respectively (50% and 5.6% in mediastinal tumors). In the lung cancer group, 5-year survival probability was 31%, and it was affected by mediastinal nodal status (5-year survival in N0–N1 patients 52%, 21% in N2 patients, 0 in N3 patients). Median survival for mediastinal tumors was 49 months.

Conclusions

In conclusion, SVC resection may achieve permanent cure in patients who would have been defined as inoperable 10 years ago. In the case of mediastinal tumors, the need for SVC resection alone should not be considered a contraindication for surgery when prosthetic replacement is feasible. In the case of lung tumors, infiltration of SVC can achieve satisfactory long-term results after neoadjuvant chemotherapy, only when pathologic N2 disease is excluded by preoperative mediastinoscopy.

Section snippets

Material and Methods

The primary objective of this study was to analyze the mortality, morbidity, and long-term results of SVC resection, both in terms of survival and in the patency of the prosthetic replacement, when performed. Our Ethical Committee was informed of the study and did not require approval. All patients gave their informed consent for the study.

Population

From November 1998 to May 2004, 70 patients underwent SVC system resection for either lung or mediastinal malignancies. Clinical characteristics of the population are reported in Table 2.

Fifty-two patients (42 male patients, median age 62,7 years) had SVC resection for nonsmall-cell lung cancer. Twenty-one patients (40%) underwent mediastinal investigation by mediastinoscopy before SVC surgery, and 40 (77%) received preoperative induction treatment (chemotherapy, n = 33; chemoradiation therapy,

Comment

Our series confirmed data from existing literature showing that resection of the SVC is a feasible additional procedure during resection of pulmonary or mediastinal tumors infiltrating the venous mediastinal axis, minimally increasing postoperative complications in experienced hands. Nevertheless, two questions regarding SVC surgery remain unaswered: what are the defining characteristics of an optimum candidate for SVC resection, and which SVC reconstruction technique provides the best results.

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