Superior vena cava resection for lung and mediastinal malignancies: a single-center experience with 70 cases.
BACKGROUND
The oncologic value of superior vena cava (SVC) resection for lung and mediastinal malignancies remains controversial. In this context, we have reviewed our experience in the treatment of locally advanced lung and mediastinal tumor invading the SVC system, analyzing postoperative outcome and long-term oncologic results.


METHODS
The clinical data of patients who underwent SVC resection were retrospectively analyzed to assess postoperative mortality, and overall and procedure-specific morbidity. Overall survival was calculated for mediastinal and lung tumor groups.


RESULTS
From 1998 to 2004, 70 consecutive patients (52 with lung cancer and 18 with mediastinal tumors) underwent SVC system resection. There were 25 replacements (36%) of the SVC system by prosthesis, whereas the remaining underwent partial resection. Major postoperative morbidity and mortality rates in lung cancer patients were 23% and 7.7%, respectively (50% and 5.6% in mediastinal tumors). In the lung cancer group, 5-year survival probability was 31%, and it was affected by mediastinal nodal status (5-year survival in N0-N1 patients 52%, 21% in N2 patients, 0 in N3 patients). Median survival for mediastinal tumors was 49 months.


CONCLUSIONS
In conclusion, SVC resection may achieve permanent cure in patients who would have been defined as inoperable 10 years ago. In the case of mediastinal tumors, the need for SVC resection alone should not be considered a contraindication for surgery when prosthetic replacement is feasible. In the case of lung tumors, infiltration of SVC can achieve satisfactory long-term results after neoadjuvant chemotherapy, only when pathologic N2 disease is excluded by preoperative mediastinoscopy.
Spaggiari
Lorenzo
L
Division of Thoracic Surgery, European Institute of Oncology, University of Milan School of Medicine, Milan, Italy. lorenzo.spaggiari@ieo.it
Leo
Francesco
F
Veronesi
Giulia
G
Solli
Piergiorgio
P
Galetta
Domenico
D
Tatani
Brunilda
B
Petrella
Francesco
F
Radice
Davide
D
D000368:Aged; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008479:Mediastinal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009367:Neoplasm Staging; D011138:Polytetrafluoroethylene; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D013927:Thrombosis / Q000209:etiology; D014683:Vena Cava, Superior / Q000601:surgery*
D011138:Polytetrafluoroethylene