15 years single center experience with surgical resection of the superior vena cava for non-small cell lung cancer.
OBJECTIVE
To examine our results with surgery for locally advanced non-small cell lung cancer (NSCLC) invading the superior vena cava (SVC).


METHODS
A retrospective analysis of patients who underwent resection between 1988 and 2003 was performed. Postoperative morbidity, long-term survival, including risk factors for overall and disease-free survival were examined.


RESULTS
Median age of the 15 operated patients was 60 years (28-78). All had direct SVC invasion by tumor. All underwent mediastinoscopy. Seven patients with N2 disease, and one with a bulky right upper lobe tumor received induction therapy. Eight underwent lobectomy (three sleeve), and seven had pneumonectomy (two carinal). The SVC was replaced by interposition graft in nine patients, whereas six had partial resection. There were two postoperative deaths (14%) and three major morbidities (23%). There was one late graft thrombosis. Mean follow-up was 25 months (3-132, median 11). Overall 1 and 3-year survival was 68 and 57% and disease-free survival was 55 and 27%, respectively. All late deaths were due to recurrence. Survival of patients with N2 disease was not significantly worse than those with localized (N0/N1) nodal disease. There was a trend towards later recurrence in patients who had induction therapy (median disease-free interval of 29 months versus 5 months in the untreated group, P = 0.3), but there was no significant effect on overall survival. The extent of lung resection and type of SVC procedure did not influence long-term survival.


CONCLUSIONS
Carefully selected patients with NSCLC and SVC involvement can be operated upon with acceptable postoperative morbidity and mortality. Induction therapy appears to delay recurrence.
Division of Thoracic Surgery, University Health Network (Princess Margaret Hospital and Toronto General Hospital) and the University of Toronto, 10EN-233, Toronto, ON M5G 2C4, Canada.
Yaron
Y
Shargall
Marc
M
de Perrot
Shaf
S
Keshavjee
Gail
G
Darling
Robert
R
Ginsberg
Michael
M
Johnston
Andrew
A
Pierre
Thomas K
TK
Waddell
D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D011013:Pneumonectomy; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014683:Vena Cava, Superior / Q000473:pathology* / Q000601:surgery*