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Thorac Cardiovasc Surg 2021; 69(02): 165-172
DOI: 10.1055/s-0039-3401044
Original Thoracic

Prosthetic Reconstruction of Superior Vena Cava System for Thymic Tumor: A Retrospective Analysis of 22 Cases

Zhenglong Zhang 
1   Department of Thoracic Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, China
,
Minhui Huang
2   International Medical Examination Center, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
,
Xiaojie Pan
1   Department of Thoracic Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, China
› Author Affiliations Funding This study is supported by Qihang Fund from Fujian Medical University (2016Q120).
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Abstract

Objective This study aimed to report our experience in superior vena cava (SVC) resection and reconstruction for 22 thymic tumor patients and to make comparisons with previous related reports.

Methods A retrospective study on 22 patients (15 thymomas, 7 thymic cancers) who underwent tumor resection with concomitant SVC reconstruction. All the patients underwent vascular conduit reconstruction by the cross-clamping technique. The corresponding data were reviewed, including clinical presentation, operation management (surgery procedure, selection of suitable graft, strategies against SVC syndrome, etc.), postoperative cares (antithrombotic agent application, treatments on brain edema, etc.), and follow-up information.

Result Two patients were myasthenic, well controlled by oral pyridostigmine. All resections were radical (R0). Ten patients received induction treatment. All the 15 thymoma patients were Masaoka stage III (type B1–B3). As for thymic cancer, six patients were Masaoka stage III and one was stage IVa. Wedge pulmonary resection was performed in three patients (two right upper lobe, one both upper lobe). Procedures included were single graft replacement in 12 patients, bilateral grafts in 9, and Y-shaped graft in 1 patient. Anticoagulation and dehydration agents were routinely applied after operation. No perioperative mortalities were observed. Major complication rate was 9.1%. The median survival time was 44.2 months (range, 4–92 months). Three- and 5-year overall survival rates were 80.8 and 44.0%, respectively. As for conduit patency, two grafts (9.1%) demonstrated evidence of occlusion during long-term follow-up, but no additional interventions were required due to no complications related.

Conclusion Our study, confirming data from existing literature, showed that the prosthetic reconstruction of the SVC system is a feasible additional procedure during resection of thymic tumor infiltrating the venous mediastinal axis, minimally increasing postoperative complications in experienced hands.

Keywords

thymus - thymoma - mediastinal tumor - vascular science - biochemistry - pharmacology - pathology


Publication History

Received: 29 August 2019

Accepted: 30 October 2019

Article published online:
31 January 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Youlden DR, Cramb SM, Baade PD. The International Epidemiology of Lung Cancer: geographical distribution and secular trends. J Thorac Oncol 2008; 3 (08) 819-831
    CrossrefPubMedGoogle Scholar
  • 2 Picquet J, Blin V, Dussaussoy C, Jousset Y, Papon X, Enon B. Surgical reconstruction of the superior vena cava system: indications and results. Surgery 2009; 145 (01) 93-99
    CrossrefPubMedGoogle Scholar
  • 3 Sun Y, Gu C, Shi J. et al. Reconstruction of mediastinal vessels for invasive thymoma: a retrospective analysis of 25 cases. J Thorac Dis 2017; 9 (03) 725-733
    CrossrefPubMedGoogle Scholar
  • 4 Lü WD, Yu FL, Wu ZS. Superior vena cava reconstruction using bovine jugular vein conduit. Eur J Cardiothorac Surg 2007; 32 (05) 816-817
    CrossrefPubMedGoogle Scholar
  • 5 Garcia A, Flores RM. Surgical management of tumors invading the superior vena cava. Ann Thorac Surg 2008; 85 (06) 2144-2146
    CrossrefPubMedGoogle Scholar
  • 6 Schoof PH, Koch AD, Hazekamp MG, Waterbolk TW, Ebels T, Dion RA. Bovine jugular vein thrombosis in the Fontan circulation. J Thorac Cardiovasc Surg 2002; 124 (05) 1038-1040
    CrossrefPubMedGoogle Scholar
  • 7 Leo F, Bellini R, Conti B, Delledonne V, Tavecchio L, Pastorino U. Superior vena cava resection in thoracic malignancies: does prosthetic replacement pose a higher risk?. Eur J Cardiothorac Surg 2010; 37 (04) 764-769
    CrossrefPubMedGoogle Scholar
  • 8 Kesler KA. Technique of mediastinal germ cell tumor resection. Oper Tech Thorac Cardiovasc Surg 2009; 14: 55-65
    CrossrefPubMedGoogle Scholar
  • 9 Sekine Y, Suzuki H, Saitoh Y, Wada H, Yoshida S. Prosthetic reconstruction of the superior vena cava for malignant disease: surgical techniques and outcomes. Ann Thorac Surg 2010; 90 (01) 223-228
    CrossrefPubMedGoogle Scholar
  • 10 Borri A, Leo F, Veronesi G. et al. Extended pneumonectomy for non-small cell lung cancer: morbidity, mortality, and long-term results. J Thorac Cardiovasc Surg 2007; 134 (05) 1266-1272
    CrossrefPubMedGoogle Scholar
  • 11 Spaggiari L, Leo F, Veronesi G. et al. Superior vena cava resection for lung and mediastinal malignancies: a single-center experience with 70 cases. Ann Thorac Surg 2007; 83 (01) 223-229 , discussion 229–230
    CrossrefPubMedGoogle Scholar
  • 12 Lanuti M, De Delva PE, Gaissert HA. et al. Review of superior vena cava resection in the management of benign disease and pulmonary or mediastinal malignancies. Ann Thorac Surg 2009; 88 (02) 392-397
    CrossrefPubMedGoogle Scholar
  • 13 Nakano T, Endo S, Kanai Y. et al. Surgical outcomes after superior vena cava reconstruction with expanded polytetrafluoroethylene grafts. Ann Thorac Cardiovasc Surg 2014; 20 (04) 310-315
    CrossrefPubMedGoogle Scholar
  • 14 Oizumi H, Suzuki K, Banno T, Matsunaga T, Oh S, Takamochi K. Patency of grafts after total resection and reconstruction of the superior vena cava for thoracic malignancy. Surg Today 2016; 46 (12) 1421-1426
    CrossrefPubMedGoogle Scholar
  • 15 Okereke IC, Kesler KA, Rieger KM. et al. Results of superior vena cava reconstruction with externally stented-polytetrafluoroethylene vascular prostheses. Ann Thorac Surg 2010; 90 (02) 383-387
    CrossrefPubMedGoogle Scholar
  • 16 Windisch T, Fischer JR, Vega A, Decker S, Held M, Graeter TP. [Infiltration of the superior vena cava in NSCLC: results of surgical intervention]. Pneumologie 2015; 69 (01) 23-29
    PubMedGoogle Scholar
  • 17 Lee GD, Kim HR, Choi SH, Kim YH, Kim DK, Park SI. Prosthetic graft interposition of the brachiocephalic veins or superior vena cava combined with resection of malignant tumours: graft patency and risk factors for graft occlusion. J Thorac Dis 2016; 8 (01) 61-67
    PubMedGoogle Scholar
  • 18 Chen KN, Xu SF, Gu ZD. et al. Surgical treatment of complex malignant anterior mediastinal tumors invading the superior vena cava. World J Surg 2006; 30 (02) 162-170
    CrossrefPubMedGoogle Scholar
  • 19 Yang HX, Hou X, Lin P, Rong TH, Yang H, Fu JH. Survival and risk factors of surgically treated mediastinal invasion T4 non-small cell lung cancer. Ann Thorac Surg 2009; 88 (02) 372-378
    CrossrefPubMedGoogle Scholar
  • 20 Maurizi G, Poggi C, D'Andrilli A. et al. Superior vena cava replacement for thymic malignancies. Ann Thorac Surg 2019; 107 (02) 386-392
    CrossrefPubMedGoogle Scholar
  • 21 Hamanaka K, Koyama T, Matsuoka S. et al. Analysis of surgical treatment of Masaoka stage III-IV thymic epithelial tumors. Gen Thorac Cardiovasc Surg 2018; 66 (12) 731-735
    CrossrefPubMedGoogle Scholar
  • 22 Omasa M, Date H, Sozu T. et al; Japanese Association for Research on the Thymus. Postoperative radiotherapy is effective for thymic carcinoma but not for thymoma in stage II and III thymic epithelial tumors: the Japanese Association for Research on the Thymus Database Study. Cancer 2015; 121 (07) 1008-1016
    CrossrefPubMedGoogle Scholar
  • 23 Kayata H, Isaka M, Ohde Y, Takahashi T, Harada H. Complete resection of Masaoka stage IVb thymic carcinoma after chemoradiotherapy. Ann Thorac Surg 2017; 103 (01) e5-e7
    CrossrefPubMedGoogle Scholar
  • 24 Ried M, Neu R, Schalke B, von Süßkind-Schwendi M, Sziklavari Z, Hofmann HS. Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support. J Cardiothorac Surg 2015; 10: 137
    CrossrefPubMedGoogle Scholar
  • 25 Shintani Y, Ohta M, Minami M. et al. Long-term graft patency after replacement of the brachiocephalic veins combined with resection of mediastinal tumors. J Thorac Cardiovasc Surg 2005; 129 (04) 809-812
    CrossrefPubMedGoogle Scholar
  • 26 Dai W, Dong J, Zhang H, Yang X, Li Q. Superior vena cava replacement combined with venovenous shunt for lung cancer and thymoma: a case series. J Thorac Dis 2018; 10 (01) 363-370
    CrossrefPubMedGoogle Scholar
  • 27 Hou X, Yang X, Du Z. et al. Superior vena cava drainage improves upper body oxygenation during veno-arterial extracorporeal membrane oxygenation in sheep. Crit Care 2015; 19: 68
    CrossrefPubMedGoogle Scholar
  • 28 Shimizu N, Tanaka Y, Kuroda S. et al. [Temporary bypass with 5-Fr catheter for reconstruction of superior vena cava]. Kyobu Geka 2018; 71 (13) 1077-1080
    PubMedGoogle Scholar
  • 29 Marulli G, Lucchi M, Margaritora S. et al. Surgical treatment of stage III thymic tumors: a multi-institutional review from four Italian centers. Eur J Cardiothorac Surg 2011; 39 (03) e1-e7
    CrossrefPubMedGoogle Scholar
  • 30 Leuzzi G, Rocco G, Ruffini E. et al; ESTS Thymic Working Group. Multimodality therapy for locally advanced thymomas: a propensity score-matched cohort study from the European Society of Thoracic Surgeons Database. J Thorac Cardiovasc Surg 2016; 151 (01) 47-57.e1
    CrossrefPubMedGoogle Scholar