title: The difficult approach to neoplastic superior vena cava syndrome: surgical option.
abstract: OBJECTIVE
  Superior vena cava syndrome is a dramatic event that can be cured in specialized centers.
  
  
  METHODS
  Between 1989 and 1995 6 patients with superior vena cava syndrome underwent surgical treatment for thoracic tumors. In all cases the vena was restricted by a neoplastic sleeve. A median sternotomy was performed in all cases. Two patients received an associated right anterolateral thoracotomy to obtain good surgical exposure for tumor resection and grafting. A 12 mm diameter polytetrafluoroethylene graft was inserted in all cases. The tumor resection was radical in 4 cases (2 thymic carcinomas, 2 malignant germ cell tumors) and palliative in 2 (1 non-small cell lung cancer and 1 mediastinal fibrosis).
  
  
  RESULTS
  We had no in-hospital mortality. All patients had immediate relief of obstruction after by-pass. Three patients were alive without disease at the end of follow-up (40-96 mo), one patient died of postoperative complications after 4 mo, 2 patients died of disease after 4 and 12 mo.
  
  
  CONCLUSIONS
  PTFE by-pass graft for treatment of the obstructed SVC relieves SVC syndrome and has good medium term patency.
authors.affiliation: Division of Thoracic Surgery, Istituto Nazionale Tumori, Milan, Italy. lequaglie@istitutotumori.mi.it
authors.forename: C
authors.initials: C
authors.lastname: Lequaglie
authors.forename: B
authors.initials: B
authors.lastname: Conti
authors.forename: P P
authors.initials: PP
authors.lastname: Brega-Massone
authors.forename: G
authors.initials: G
authors.lastname: Giudice
mesh_terms: D000328:Adult; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D008297:Male; D008479:Mediastinal Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures / Q000379:methods*; D013479:Superior Vena Cava Syndrome / Q000209:etiology* / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000473:pathology / Q000601:surgery