Superior vena cava resection in thoracic malignancies: does prosthetic replacement pose a higher risk?☆

Leo, Francesco; Bellini, Roberto; Conti, Bárbara; Delledonne, Vincenzo; Tavecchio, Luca; Pastorino, Ugo

doi:10.1016/j.ejcts.2009.10.024

Cited by 34 publications

(37 citation statements)

References 12 publications

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“…Our study, confirming data from the existing literature (►Table 2), 3,7,9,[13][14][15][16][17] showed that prosthetic reconstruction of the SVC system is a feasible additional procedure during resection of thymic tumor, which infiltrates the venous mediastinal axis minimally increasing postoperative complications in experienced hands. Nevertheless, some points regarding SVC surgery remain controversial, involving optimal procedure, graft size and type, postoperative cares, etc.…”

Section: Discussionsupporting

confidence: 89%

“…(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.…”

Section: Against Brain Edemamentioning

confidence: 99%

“…[4][5][6] Several investigators have reported favorable results when combining malignant tissue resection using ringed ePTFE grafts in vascular reconstruction. [7][8][9] The reported 5-year survival rates of complete "en bloc" resection with SVC reconstruction are 31% in patients with nonsmall-cell lung cancer and 42% in patients with thymic tumors. 2,10 In recent years, the ringed ePTFE prosthesis has the advantage of "rings," which can avoid graft collapses when the central venous pressure becomes negative.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Huang

Pan

2020

Thorac Cardiovasc Surg

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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.

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Section: Discussionsupporting

confidence: 89%

Section: Against Brain Edemamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Zhang

Huang

Pan

2020

Thorac Cardiovasc Surg

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“…Moreover, vessel reconstruction caused by primary lung cancer rather than invasive thymoma was commonly found in previous reports (6,12,13). Thus, we reviewed our experience with reconstruction of mediastinal vessels for invasive thymoma.…”

Section: Original Articlementioning

confidence: 99%

“…Among all the surgery options, complete resection, along with vessel replacement and reconstruction, has been proved to be the best option (6). Even though most prosthetic replacements were operated in patients suffered from advanced lung cancer, it still remains an important place in treating patients with invasive thymoma (7).…”

Section: Original Articlementioning

confidence: 99%

Reconstruction of mediastinal vessels for invasive thymoma: a retrospective analysis of 25 cases

Sun

Shi

et al. 2017

J. Thorac. Dis.

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Background: Discuss an appropriate strategy for treatment of invasive thymoma invading adjacent great vessels.Methods: A retrospective study on 25 patients with invasive thymoma invading neighboring great vessels was performed. The corresponding data including clinical presentation, operation procedure, adjuvant radiochemotherapy and follow-up were reviewed. Postoperatively, three cases suffered from pulmonary infection, and three cases had haemothorax, chylothorax and atelectasis, respectively. Two patients died due to acute respiratory distress syndrome within 90 days after the surgery. Within the remaining patients, 11 cases (44%) experienced a relapse and finally 8 (32%) patients died. Compared to R1 resection group, R0 resection group had a better prognosis (Log-rank P=0.0196). The 3-and 5-year survival rates were 79.6% and 59.1%, with median survival time of 84 months.Conclusions: Reconstruction of mediastinal vessels for invasive thymoma is a feasible technology method.Radical resection of the tumor with involved neighboring structures is the key to prolong overall survival for patients suffered from invasive thymoma.

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Patency of grafts after total resection and reconstruction of the superior vena cava for thoracic malignancy

et al. 2016

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Superior vena cava resection in thoracic malignancies: does prosthetic replacement pose a higher risk?☆

Abstract: Complete prosthetic replacement does not increase overall postoperative morbidity in patients undergoing SVC resection and can be safely performed when other reconstruction techniques preclude sufficient tumour-free resection margin or compromise adequate blood flow.

Cited by 34 publications

References 12 publications

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

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

Reconstruction of mediastinal vessels for invasive thymoma: a retrospective analysis of 25 cases

Patency of grafts after total resection and reconstruction of the superior vena cava for thoracic malignancy

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