title: Review of superior vena cava resection in the management of benign disease and pulmonary or mediastinal malignancies.
abstract: BACKGROUND
  Obstruction of the superior vena cava (SVC) by tumor or benign disease implies unreconstructable disease and poor outcome. We analyzed the operative results, graft patency, and survival in patients undergoing SVC resection and reconstruction for benign disease and pulmonary or mediastinal malignancy.
  
  
  METHODS
  Patients undergoing SVC resection from 1997 to 2007 for surgical management of benign and invasive neoplasms were retrospectively reviewed.
  
  
  RESULTS
  We identified 19 patients requiring SVC resection. Malignant disease was resected in 17: lung cancer in 9 and mediastinal malignancy in 8. Two patients (10%) with benign processes required reconstruction for chronic SVC syndrome. Ringed Gore-Tex conduit (W. L. Gore and Associates, Flagstaff, AZ) was used for 12 reconstructions (63%) of the SVC, and 7 patients underwent primary closure or autologous pericardial patch repair. Preoperative chemoradiotherapy was administered to 9 patients (53%). There was one perioperative death (5%). Major postoperative morbidities included atrial fibrillation in 5, stroke in 2, respiratory failure in 3, myocardial infarction in 1, and Horner syndrome in 1. Median survival for the entire cohort was 45.5 months (range, 0.2 to 147 months), with a mean follow-up of 45.8 months. Five-year survival probability was 30% for patients with resected lung cancer and 56% for patients with resected anterior mediastinal malignancies.
  
  
  CONCLUSIONS
  Resection and reconstruction may be safely performed in selected patients for benign and malignant obstruction or infiltration of the SVC. Survival and intermediate-term patency after tubular grafting of the SVC are acceptable.
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA. mlanuti@partners.org
authors.forename: Michael
authors.initials: M
authors.lastname: Lanuti
authors.forename: Pierre E
authors.initials: PE
authors.lastname: De Delva
authors.forename: Henning A
authors.initials: HA
authors.lastname: Gaissert
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.forename: John C
authors.initials: JC
authors.lastname: Wain
authors.forename: James S
authors.initials: JS
authors.lastname: Allan
authors.forename: Dean M
authors.initials: DM
authors.lastname: Donahue
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Mathisen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019917:Blood Vessel Prosthesis Implantation; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008479:Mediastinal Neoplasms / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D012189:Retrospective Studies; D014654:Vascular Patency; D014683:Vena Cava, Superior / Q000601:surgery*