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  • Title: Prosthetic reconstruction of the superior vena cava for malignant disease: surgical techniques and outcomes.
    Author: Sekine Y, Suzuki H, Saitoh Y, Wada H, Yoshida S.
    Journal: Ann Thorac Surg; 2010 Jul; 90(1):223-8. PubMed ID: 20609780.
    Abstract:
    BACKGROUND: This retrospective study investigated long-term graft patency and outcomes for malignant diseases with invasion of the superior vena cava (SVC). METHODS: From October 1995 to November 2008, 20 patients underwent combined surgical resection of malignant tumors and the SVC with vascular reconstruction using a ringed polytetrafluoroethylene graft (8 to 12 mm) Sigmoid-curved spatulation of the graft end at the right auricle was performed to obtain a wide orifice left graft. Anticoagulation therapy was routinely administered for 3 to 6 months. Postoperative graft patency was verified at 2 to 4 weeks, 3 months, and after 12 months. Indications were lung cancer in 9 patients, thymic tumors in 8, germ cell tumors in 2, and thyroid cancer in 1. RESULTS: Procedures were single graft replacement in 9 patients, bilateral grafts in 10, and bilateral SVC grafts and 1 pulmonary artery graft in 1. All grafts were patent over a short-term period, but 1 limb of the bilateral grafts became occluded in 2 patients who received bilateral grafts during long-term follow-up. Bronchial dehiscence after lung cancer resection caused 1 in-hospital death. Mean follow-up was 44.7 months. Median survival was 22.1 months. Overall survival was 66.4% and 41.5% at 1 and 5 years, respectively. Survival for lung cancer was significantly worse at 5 years (62.5%) than thymic tumor (18.8%, p = 0.04). CONCLUSIONS: Prosthetic reconstruction of the SVC for anterior mediastinal tumors and lung cancer is feasible. Reconstruction of the SVC using a single left graft to avoid total cross-clamping of the SVC is effective.
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