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European Journal of Cardio-Thoracic Surgery, Vol 8, 177-182, Copyright © 1994 by European Association for Cardio-thoracic Surgery
P Thomas, PE Magnan, G Moulin, R Giudicelli and P Fuentes
Between 1981 and 1991, 845 patients were operated on for right lung cancer.
Among them, 50 (6%) had a tumor invading the superior vena cava (SVC).
Fifteen patients (14 men and 1 woman, mean age: 58 years) underwent radical
resection with concomitant vascular reconstruction. Two patients presented
with a superior vena caval syndrome. The SVC was invaded by direct
extension from the tumor (n = 11) or by paratracheal nodal involvement (n =
4). The patients required pneumonectomy (n = 13) or upper lobectomy (n =
2), with lateral (n = 11) or circumferential resection (n = 4) of the SVC.
The venous pathway was repaired by direct suture (n = 9), prosthetic patch
(n = 2) or polytetrafluoroethylene (PTFE) graft (n = 4). Tumor resection
was considered macroscopically complete in 12 patients (80%). One patient
died postoperatively (7%) and non-fatal complications occurred in 3 (20%).
Early patency of the four grafts was assessed by phlebography. In the late
course, pulmonary embolism occurred in two patients and extended superior
vena caval thrombosis in one; the overall clinical patency rate was 75.7%
at 1 and 5 years. Two patients (13.3%) experienced mediastinal recurrence;
the overall survival rates at 1 year, 2 years and 5 years were,
respectively, 46.7%, 32% and 24% (median: 8.5 months). We conclude that
extended resection for lung cancer invading the SVC, when feasible, is
justified given the effective control of the primary tumor thereby
provided, with an acceptable operative risk.
ARTICLES
Extended operation for lung cancer invading the superior vena cava
Department of Thoracic Surgery, Sainte-Marguerite Hospital, Marseilles, France.
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