title: Surgical management of thoracic malignancies invading the heart or great vessels.
abstract: BACKGROUND
  Surgical resection of thoracic malignancies involving either the heart or great vessels is uncommonly performed because of the potential morbidity and mortality for an unknown probability of significant palliation or cure. We reviewed our experience of 10 patients treated surgically, either primarily or as a component of multimodality therapy, to assess feasibility and results.
  
  
  METHODS
  A retrospective review of the results in 10 patients who underwent resection of thoracic malignancies that included either great vessel or the heart was conducted.
  
  
  RESULTS
  Histologic diagnoses included soft tissue sarcoma (n = 7), squamous cell carcinoma (n = 1), malignant thymoma (n = 1), and mediastinal teratoma (n = 1). Three patients underwent induction chemotherapy. Cardiopulmonary bypass was used in 7 patients. Structures resected included superior vena cava (n = 5), left atrium (n = 4), right atrium (n = 2), descending aorta (n = 1), and main pulmonary artery (n = 1). Concomitant anatomic pulmonary resections were performed in 3 patients. Seven patients had an R0 or R1 resection. There were no perioperative deaths. All symptomatic patients had immediate and sustained palliation of their presenting symptoms. The median length of stay was 6 days (range, 4 to 43 days). Six patients underwent postoperative systemic therapy. The overall median survival was 21.7 months (range, 3.2 to 69 months) and was 33.3 months (range, 3.7 to 69 months) for patients who had an R0 or R1 resection.
  
  
  CONCLUSIONS
  Resection of the heart and great vessels involved by thoracic malignancies can be performed with acceptable morbidity and mortality and results in significant palliation and, in some cases, prolonged survival.
authors.affiliation: Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. parkb@mskcc.org
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Park
authors.forename: Matthew
authors.initials: M
authors.lastname: Bacchetta
authors.forename: Manjit S
authors.initials: MS
authors.lastname: Bains
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Downey
authors.forename: Raja
authors.initials: R
authors.lastname: Flores
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Girardi
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001013:Aorta, Thoracic / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D017024:Chemotherapy, Adjuvant; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology; D006338:Heart Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000175:diagnosis / Q000473:pathology*; D011651:Pulmonary Artery / Q000473:pathology; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D013724:Teratoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D013945:Thymoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D013953:Thymus Neoplasms / Q000175:diagnosis / Q000473:pathology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D019043:Vascular Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D014683:Vena Cava, Superior / Q000473:pathology