Top

Surgery Today

Published in:

01-12-2016 | Original Article

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

Authors: Hiroaki Oizumi, Kenji Suzuki, Takamitsu Banno, Takeshi Matsunaga, Shiaki Oh, Kazuya Takamochi

Published in: Surgery Today | Issue 12/2016

Abstract

Purposes

Resection and reconstruction of the superior vena cava (SVC) is used for the complete resection of advanced lung cancer and mediastinal tumors. However, the optimal postoperative management for this procedure remains to be elucidated.

Methods

1897 patients with lung cancer and/or mediastinal tumors underwent surgical resection at our institute. Among them, 12 patients underwent combined resection and replacement with a vascular graft of the SVC. Preoperative SVC syndrome was noted in 4, and preoperative chemo and/or radiotherapy were used in 2. The SVC pathway was reconstructed bilaterally in 9 patients (75 %), while 2 patients underwent a right-side single bypass, and 1 had a Y-shaped bypass. Antithrombotic agents were not used postoperatively. The factors related to occlusion of the graft were investigated. The median follow-up time for the surviving patients was 474 days.

Results

There were no instances of surgical mortality. Among the 22 grafts, three (14 %) were occluded. One (8 %) case of occlusion was noted on the right side and 2 (20 %) in the left graft. Bilateral reconstruction was performed in all except 2. Two single side reconstructions did not result in occlusion, while 3 occlusions were noted in the patients who had undergone bilateral reconstruction.

Conclusion

Resection and reconstruction of the SVC system was feasible. Postoperative anti-thrombotic agents are not always needed to prevent acute graft occlusion.

Suzuki K, Asamura H, Watanabe S, Tsuchiya R. Combined resection of superior vena cava for lung carcinoma: prognostic significance of patterns of superior vena cava invasion. Ann Thorac Surg. 2004;78(4):1184–9; discussion-9.

Dartevelle PG, Chapelier AR, Pastorino U, Corbi P, Lenot B, Cerrina J, et al. Long-term follow-up after prosthetic replacement of the superior vena cava combined with resection of mediastinal-pulmonary malignant tumors. J Thorac Cardiovasc Surg. 1991;102(2):259–65.PubMed

Lanuti M, De Delva PE, Gaissert HA, Wright CD, Wain JC, Allan JS, et al. Review of superior vena cava resection in the management of benign disease and pulmonary or mediastinal malignancies. Ann Thorac Surg. 2009;88(2):392–7.CrossRefPubMed

Leo F, Bellini R, Conti B, Delledonne V, Tavecchio L, Pastorino U. Superior vena cava resection in thoracic malignancies: does prosthetic replacement pose a higher risk? Eur J Cardiothorac Surg. 2010;37(4):764–9.CrossRefPubMed

Sekine Y, Suzuki H, Saitoh Y, Wada H, Yoshida S. Prosthetic reconstruction of the superior vena cava for malignant disease: surgical techniques and outcomes. Ann Thorac Surg. 2010;90(1):223–8.CrossRefPubMed

Shargall Y, de Perrot M, Keshavjee S, Darling G, Ginsberg R, Johnston M, et al. 15 years single center experience with surgical resection of the superior vena cava for non-small cell lung cancer. Lung cancer (Amsterdam, Netherlands). 2004;45(3):357–63.

Shintani Y, Ohta M, Minami M, Shiono H, Hirabayashi H, Inoue M, et al. Long-term graft patency after replacement of the brachiocephalic veins combined with resection of mediastinal tumors. J Thorac Cardiovasc Surg. 2005;129(4):809–12.CrossRefPubMed

Spaggiari L, Leo F, Veronesi G, Solli P, Galetta D, Tatani B, et al. Superior vena cava resection for lung and mediastinal malignancies: a single-center experience with 70 cases. Ann Thorac Surg. 2007;83(1):223–9; discussion 9–30.

Spaggiari L, Thomas P, Magdeleinat P, Kondo H, Rollet G, Regnard JF, et al. Superior vena cava resection with prosthetic replacement for non-small cell lung cancer: long-term results of a multicentric study. Eur J Cardiothorac Surg. 2002;21(6):1080–6.CrossRefPubMed

10.

Nakano T, Endo S, Kanai Y, Otani S, Tsubochi H, Yamamoto S, et al. Surgical outcomes after superior vena cava reconstruction with expanded polytetrafluoroethylene grafts. Ann Thor Cardiovasc Surg Off J Assoc Thor Cardiovasc Surg Asia. 2014;20(4):310–5.

11.

Picquet J, Blin V, Dussaussoy C, Jousset Y, Papon X, Enon B. Surgical reconstruction of the superior vena cava system: indications and results. Surgery. 2009;145(1):93–9.CrossRefPubMed

Title: Patency of grafts after total resection and reconstruction of the superior vena cava for thoracic malignancy
Authors: Hiroaki Oizumi
Kenji Suzuki
Takamitsu Banno
Takeshi Matsunaga
Shiaki Oh
Kazuya Takamochi
Publication date: 01-12-2016
Publisher: Springer Japan
Published in: Surgery Today / Issue 12/2016
Print ISSN: 0941-1291
Electronic ISSN: 1436-2813
DOI: https://doi.org/10.1007/s00595-016-1347-z

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Purposes

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purposes

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2016

Malignancies after living-donor and cadaveric lung transplantations in Japanese patients

Perioperative circulating tumor cells in surgical patients with non-small cell lung cancer: does surgical manipulation dislodge cancer cells thus allowing them to pass into the peripheral blood?

The effects of bevacizumab on intestinal anastomotic healing in rabbits

Risk factors for early renal dysfunction following endovascular aortic aneurysm repair and its effect on the postoperative outcome

Retroileal colorectal anastomosis after extended left colectomy: application for laparoscopic surgery

Efficacy and hemodynamic response of pleural carbon dioxide insufflation during thoracoscopic surgery in a swine vessel injury model