Patency of grafts after total resection and reconstruction of the superior vena cava for thoracic malignancy.
OBJECTIVE
Resection and reconstruction of the superior vena cava (SVC) is used for the complete resection of advanced lung cancer and mediastinal tumors. However, the optimal postoperative management for this procedure remains to be elucidated.


METHODS
1897 patients with lung cancer and/or mediastinal tumors underwent surgical resection at our institute. Among them, 12 patients underwent combined resection and replacement with a vascular graft of the SVC. Preoperative SVC syndrome was noted in 4, and preoperative chemo and/or radiotherapy were used in 2. The SVC pathway was reconstructed bilaterally in 9 patients (75 %), while 2 patients underwent a right-side single bypass, and 1 had a Y-shaped bypass. Antithrombotic agents were not used postoperatively. The factors related to occlusion of the graft were investigated. The median follow-up time for the surviving patients was 474 days.


RESULTS
There were no instances of surgical mortality. Among the 22 grafts, three (14 %) were occluded. One (8 %) case of occlusion was noted on the right side and 2 (20 %) in the left graft. Bilateral reconstruction was performed in all except 2. Two single side reconstructions did not result in occlusion, while 3 occlusions were noted in the patients who had undergone bilateral reconstruction.


CONCLUSIONS
Resection and reconstruction of the SVC system was feasible. Postoperative anti-thrombotic agents are not always needed to prevent acute graft occlusion.
Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3 Chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
Hiroaki
H
Oizumi
Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3 Chome, Bunkyo-ku, Tokyo, 113-8431, Japan. kjsuzuki@juntendo.ac.jp.
Kenji
K
Suzuki
Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3 Chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
Takamitsu
T
Banno
Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3 Chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
Takeshi
T
Matsunaga
Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3 Chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
Shiaki
S
Oh
Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3 Chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
Kazuya
K
Takamochi
D000328:Adult; D000368:Aged; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000517:prevention & control; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008479:Mediastinal Neoplasms / Q000601:surgery*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods*; D014683:Vena Cava, Superior / Q000601:surgery*
Local recurrence; Lung cancer; Thrombosis