Superior vena cava replacement combined with venovenous shunt for lung cancer and thymoma: a case series

Abstract

Background: Superior vena cava (SVC) replacement is infrequently performed and technically challenging in low-volume centers. Venovenous shunt (VVS) technique is used to reduce SVC pressure during SVC replacement and has not been well reported. This study aimed to add information on this subject and evaluate the surgical outcomes of patients who underwent SVC replacement combined with VVS in our center.Methods: A retrospective analysis of six patients who underwent SVC replacement combined with VVS from September 2011 to February 2017 was performed. Clinical characteristics, pathological features, operative characteristics, postoperative outcomes, and the survival of the six patients were reviewed.Results: There were four males and two females with a median age of 44 years (range, 35-69 years).There were three lung cancer patients and three thymoma patients at a stage from IIIA to IVA. Five patients underwent induction therapy. Complete resection was performed on five patients. One patient underwent internal VVS, and the other five patients underwent external VVS. Prosthesis grafts were employed in five cases and autologous pericardium in one case. Three patients underwent single-vein reconstruction, and the other three patients underwent double-vein reconstruction. The median SVC clamping time was 75 minutes.There were no postoperative deaths or major complications. All patients were alive at follow-up, and no thrombosis was found in any of the grafts.Conclusions: SVC replacement combined with VVS is technically feasible and safe. Although VVS technique is not a must, it may make SVC replacement safer in inexperienced centers. Surgery-based multidisciplinary treatment for selected patients with type T4 lung cancer and SVC involvement or thymoma and SVC involvement may achieve a favorable long-term outcome.

Invasive thymoma leading to pulmonary artery embolism during operation

“…If SVC clamping time was estimated to be long in inexperienced centers, venovenous shunt technique can be considered. Dai et al [6] reported 6 patients who underwent SVC replacement combined with venovenous shunt which can be divided into external or internal kind. External venovenous shunt was performed before surgery between internal jugular vein with femoral vein, while internal venovenous shunt was instituted during surgery between right brachiocephalic vein and right atrium.…”

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

“…So far, no severe occlusion has been found due to thrombosis and our patency rate is 90.9%, better than previous studies. 23,24,26…”

“…(4) Head hypothermy before clamping and postoperative diuretic therapy contribute to the elimination of the symptoms of SVC obstruction. 3,7,26,28 This study has few significant limitations, mostly stemming from its small sample size and retrospective design. A chief issue that was raised and remained unsolved in this study is regarding the optimal duration of warfarin therapy.…”

Extracorporeal membrane oxygenation (ECMO) assisted mediastinal tumor resection and superior vena cava replacement are safe and feasible

“…Therefore, postoperative brain dysfunction occurs . If the superior vena cava is blocked, the superior vena cava blood flow can be improved to reduce cerebral venous pressure and neurological complications by venous bypass shunting, such as the innominate vein to the right atrial bypass or differential pressure drainage from the internal jugular vein to the femoral vein . However, the innominate vein to right atrial bypass technique is not suitable for patients whose innominate vein is completely invaded by tumor.…”