Extended resections for bronchogenic carcinoma invading the superior vena cava system

Background. Extended resection of non-small-cell lung cancer (NSCLC) involv ing the superior vena cava (SVC) system is infrequently performed and oncol ogic benefits are still uncertain. Methods. From 1983 to 1996, 25 patients underwent resection of the SVC syst em for T4, NSCLC. Results. A total of 12 pneumonectomies (48%), ten lobectomies (40%), and th ree wedge resections (12%) were-performed. Seven patients had complete rese ction of the SVC with graft interposition, 12 patients underwent tangential resection of the SVC, and 1 patient had a pericardial patch; 5 patients un derwent resection of right innominate and subclavian veins without vessel r econstruction. The lymph node status was NO in 8 patients (32%), NI in 3 (1 2%) and N2 in 14 patients (56%). Five patients (20%) underwent incomplete r esection. Nine patients (36%) developed postoperative complications (36%) t hat were fatal in 3 patients (12%). At the completion of the study, 10 pati ents were still alive. The median survival was 11.5 months and the 5-year a ctuarial 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 postoperativ e mortality. Even though no significant prognostic factors were observed, t he patients who required a lobectomy with limited lymph node involvement se emed to benefit the most from surgery. (C) 2000 by The Society of Thoracic Surgeons.