P. Thomas et al., EXTENDED OPERATION FOR LUNG-CANCER INVADING THE SUPERIOR VENA-CAVA, European journal of cardio-thoracic surgery, 8(4), 1994, pp. 177-182
Between 1981 and 1991, 845 patients were operated on for right lung ca
ncer. Among them, 50 (6%) had a tumor invading the superior vena cava
(SVC). Fifteen patients (14 men and 1 woman, mean age: 58 years) under
went radical resection with concomitant vascular reconstruction. Two p
atients presented with a superior vena caval syndrome. The SVC was inv
aded by direct extension from the tumor (n = 11) or by paratracheal no
dal involvement (n = 4). The patients required pneumonectomy (n = 13)
or upper lobectomy (n = 2), with lateral (n = 11) or circumferential r
esection (n = 4) of the SVC. The venous pathway was repaired by direct
suture (n = 9), prosthetic patch (n = 2) or polytetrafluoroethylene (
PTFE) graft (n = 4). Tumor resection was considered macroscopically co
mplete in 12 patients (80%). One patient died postoperatively (7%) and
non-fatal complications occurred in 3 (20%). Early patency of the fou
r grafts was assessed by phlebography. In the late course, pulmonary e
mbolism occurred in two patients and extended superior vena caval thro
mbosis in one; the overall clinical patency rate was 75.7% at 1 and 5
years. Two patients (13.3%) experienced mediastinal recurrence; the ov
erall survival rates at 1 year, 2 years and 5 years were, respectively
, 46.7%, 32% and 24% (median: 8.5 months). We conclude that extended r
esection for lung cancer invading the SVC, when feasible, is justified
given the effective control of the primary tumor thereby provided, wi
th an acceptable operative risk.