Combined tracheal sleeve and superior vena cava resections for non-small cell lung cancer

Background. Combined superior vena cava and tracheal sleeve resections are occasionally indicated in the treatment of non-small cell lung cancer. Howe ver, more effective induction therapy may potentially expand the benefit of locally extended resections. Methods. From January 1998 to December 1999, 6 consecutive patients had com bined tracheal sleeve and superior vena cava resections for non-small cell lung cancer after induction treatment. Surgical approach was muscle-sparing lateral thoracotomy in 4 patients and hemiclamshell approach in 2 patients . There were four tracheal sleeve pneumonectomies, one tracheal sleeve bilo bectomy, and one tracheal sleeve lobectomy. Three patients (50%) had comple te superior vena cava resection with graft replacement, whereas the other p atients had partial superior vena cava resection using vascular staplers. Results. There were no perioperative complications. Three patients (50%) ha d major postoperative complications, but there were no postoperative deaths . Four patients are still alive, 2 without evidence of disease. The median survival was 14.5 months (range, 3 to 17 months). Conclusions. These combined resections are technically feasible with no pos toperative mortality but high morbidity (50%). This aggressive surgery may be useful in highly selected patients where adequate local control can achi eve long-term survival. (C) 2000 by The Society of Thoracic Surgeons.