Results of superior vena cava resection in patients with lung and mediastinal tumors

Background:  Thoracic tumors involving the superior vena cava (SVC) are common in the practice of a thoracic surgeon treating cancer patients. Extended combined procedures that allow for complete removal of the tumor improves overall and disease-free survival and as such are justified from an oncologist’s perspective. In some patients, due to a long-standing SVC syndrome, the development of venous collaterals would increase the early postoperative risk of thrombus formation in the prosthesis. In such a case, it is possible to perform circular SVC resection without subsequent prosthetic replacement.  Aim:  To evaluate the short-term results of SVC resection in patients with chest tumors, to develop an algorithm and to identify the patient group in whom circular SVC without prosthetic replacement is feasible.   Materials and methods:  Twenty eight (28) patients were included into the study (22 men and 6 women, with the mean age of 55 [range, 21 to 70 years]; all of them had undergone SVC resection within the intervention for a lung or mediastinal malignancy for 10 years (from 2008 to 2018) in the Department of Thoracic Surgery, Moscow Research Institute of Oncology named after P.A. Herzen. We analyzed their short-term results of the procedures, the postoperative course, and technical particulars of the procedures.  Results:  Locally advanced lung cancer was diagnosed in 19 (67%) of the patients, thymoma in 3 (10%), lung metastatic disease in 2 (7%), germ-cell mediastinal tumors in 2 (7%), thymus cancer in 1 (3%), and residual lymphoma in 1 (3%) patient. In the majority of the patients (15 cases, 53%), the complicated clinical course had been diagnosed before surgery. In 4 patients with protracted SVC syndrome, we performed circular resection without any prosthetic replacement. In 22 patients (78%), the postoperative course was uneventful. Postoperative mortality was 7%.  Conclusion:  SVC resection can be safely performed in patients with primary mediastinal and lung tumors. With a long-standing SVC syndrome, the newly developed cava-caval anastomoses can provide significant functional support; in such patients with compensatory collateral blood flow, the circular SVC resection without prosthetic replacement is relatively safe.