Extracorporeal membrane oxygenation (ECMO) assisted mediastinal tumor resection and superior vena cava replacement are safe and feasible

Zhang, Shixin; Tan, Deli; Wu, Wei; Jiang, Tao; Tang, Meng; Wu, Tao; Liu, Hongxiang; Zhang, Ming; Zhou, Ni; Ling-feng, Tang; Qiao, Chunming; Tang, Jinghua; Xia, Mei; Huang, Aihong; Liao, Yi; Yang, Qin; Wang, Haidong

doi:10.1111/1759-7714.13140

Cited by 4 publications

(4 citation statements)

References 13 publications

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“…Because of its aggressive behavior, thymic tumors may invade adjacent organs or large vessels, such as the superior vena cava (SVC), innominate veins and pericardium, etc 3 . In recent years, several reports have described surgical resection with SVC reconstruction for the treatment of advanced thymic tumors 4,5 . However, the prognosis of the initial surgery for advanced thymic tumors invading the SVC is still not satisfactory 6,7 .…”

Section: Introductionmentioning

confidence: 99%

Surgical feasibility and long‐term outcome of superior vena cava replacement for advanced thymoma in patients undergoing preoperative chemotherapy or chemoradiotherapy

et al. 2021

Thoracic Cancer

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Background The aim of this study was to investigate the long‐term outcome of superior vena cava (SVC) replacement after chemotherapy or chemoradiotherapy for advanced thymoma. Methods The medical information of patients with advanced thymoma who underwent thymoma resection and SVC replacement in Beijing Tongren Hospital from 2002 to 2017 were reviewed. We compared surgical outcomes, postoperative complications and long‐term prognosis in the chemoradiotherapy + surgery group (CRT + surgery group, 19 cases) and the surgery group (26 cases). Results The operation time (486.05 ± 148.01 vs. 370.77 ± 124.32 min; p = 0.007) and intraoperative blood loss (1400 ml [IQR 1125–2105 ml] vs. 855 ml [IQR 555–1682.5 ml], p = 0.036), poor wound healing (three cases [15.79%] vs. zero cases [0.0%], p = 0.036) in the CRT + surgery group were significantly higher than those of the surgery group. There was no significant difference between the CRT + surgery group and the surgery group in postoperative chest tube drainage time, hospitalization time, postoperative arrhythmia and incidence of pneumonia. Kaplan Meier analysis showed that the recurrence‐free survival (RFS) curves of the CRT + surgery group patients were better than those of the surgery group (p = 0.031). However, overall survival (OS) between the two groups was not significantly different (p = 0.069). Conclusions Thymoma resection and SVC replacement is feasible for patients undergoing preoperative induction chemotherapy or chemoradiotherapy for advanced thymoma. Although patients in the CRT + surgery group had a longer operation time and increased intraoperative bleeding, the RFS rate seemed to be better than that in the surgery group.

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Section: Introductionmentioning

confidence: 99%

Surgical feasibility and long‐term outcome of superior vena cava replacement for advanced thymoma in patients undergoing preoperative chemotherapy or chemoradiotherapy

et al. 2021

Thoracic Cancer

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“…As shown in Table 2 , 42 (73%) of the patients required vascular reconstruction after vascular complications associated with tumor resection. Extracorporeal circulation was used intraoperatively in six patients (10%) [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Vascular Surgery Performed Jointly With Other Departments

Nakajima,

Shibata,

Mukawa

et al. 2023

Cureus

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Objective: The purpose of this study is to evaluate the results of vascular surgery performed at our hospital, a tertiary emergency general hospital, in patients undergoing surgery in other departments. The results of the study were reviewed. Methods: The study included cases in which cardiovascular surgery was performed at the request of other departments over a 15-year period from January 2006 to October 2022. Patient backgrounds, departments that requested surgery, surgical procedures, use of extracorporeal circulation, and surgical techniques were reviewed. Patients with femoral artery exposure or ECMO removal during transcatheter aortic valve implantation (TAVI) requested by cardiology were excluded. Results: There were 58 vascular surgery cases requested by other departments during the study period. The age was 63±14 years, 43 (74%) were male and 15 (26%) were female. The departments of the patients were urology in 29 (50%), gastroenterology in 18 (31%), orthopedics in seven (12%), emergency department in three (5%), and obstetrics and gynecology in one (2%). The following surgical procedures were performed: tumor resection and reconstruction due to tumor invasion of the inferior vena cava in 27 cases (47%), bypass to secure intraperitoneal arterial blood flow in 15 cases (26%), bypass during resection of the femoral tumor in four cases (7%), hemostasis due to trauma in three cases (5%), intraperitoneal hemostasis in three cases (5%), thrombectomy in two cases (3%), and others in four cases (7%). Extracorporeal circulation was used in six (10%) of the patients. Conclusion: A 15-year case study of vascular surgery supports operations requested by other departments at our hospital. All reconstructed sites were open at the time of discharge.

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“… 16 , 17 , 18 , 19 These risks limit the implementation of conventional thoracic surgery. Preoperative multidisciplinary consultation, detailed assessment of the positional relationship between the tumor and the surrounding tissues and organs, 11 , 20 careful management of the anesthetic process, 19 and active use of CPB or extracorporeal membrane oxygenation (ECMO) can all help thoracic surgeons to effectively overcome surgical difficulties in order to reduce the risk of the operation 5 , 21 and achieve a complete removal of tumor tissues with better prognosis. 5 , 22 …”

Section: Discussionmentioning

confidence: 99%

Cardiopulmonary bypass does not consequentially contribute to postoperative distant metastasis of giant refractory thoracic tumors: A retrospective study with long‐term follow‐up

Chen

Zhu

et al. 2021

Thoracic Cancer

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Background Few clinical research studies with long‐term follow‐up have revealed whether cardiopulmonary bypass (CPB) increases the risk of postoperative distant metastasis in patients with giant refractory thoracic tumors. The present study evaluated the risk of distant metastasis after surgery utilizing CPB with long‐term follow‐up. Methods Clinical data for patients with giant refractory thoracic tumors who underwent resection with the use of CPB in the Second Affiliated Hospital of Soochow University during the past 11 years were retrospectively reviewed. Results Of the 14 patients with giant refractory thoracic tumors who had undergone surgery under CPB, 10 patients (71.4%) were completely resected. Twelve patients were followed up for 13–127 months with 10 patients were completely resected and two patients could not be completely resected due to severe tissue invasion. Three patients (25%) suffered from distant metastasis, and four patients (33.3%) experienced local recurrence. Only one patient (1/10) with complete resection suffered from distant metastasis, while two patients (2/10) experienced local recurrence. Two patients (2/2) with major resection suffered from both distant metastasis and local recurrence. Median overall survival for patients who have been regularly followed up was 50 months with 1‐, 5‐, and 10‐year survival of 100%, 75%, and 66.7%. No difference was found between the distant metastasis survival and the local recurrence survival. (p = 0.99). Conclusions CPB is an effective strategy for complete resection of the giant refractory thoracic tumors with an acceptable risk of postoperative distant metastasis for some patients.

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Extracorporeal membrane oxygenation (ECMO) assisted mediastinal tumor resection and superior vena cava replacement are safe and feasible

Cited by 4 publications

References 13 publications

Surgical feasibility and long‐term outcome of superior vena cava replacement for advanced thymoma in patients undergoing preoperative chemotherapy or chemoradiotherapy

Surgical feasibility and long‐term outcome of superior vena cava replacement for advanced thymoma in patients undergoing preoperative chemotherapy or chemoradiotherapy

Outcomes of Vascular Surgery Performed Jointly With Other Departments

Cardiopulmonary bypass does not consequentially contribute to postoperative distant metastasis of giant refractory thoracic tumors: A retrospective study with long‐term follow‐up

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