Reconstruction of mediastinal vessels for invasive thymoma: a retrospective analysis of 25 cases

Sun, Yifeng; Gu, Chang; Shi, Jianxin; Fang, Wentao; Luo, Qingquan; Hu, De Jin; Fu, Shuangshuang; Pan, Xufeng; Chen, Yong; Yu, Yang; Yang, Haitang; Zhao, Heng; Chen, Haiquan

doi:10.21037/jtd.2017.03.03

Cited by 27 publications

(25 citation statements)

References 27 publications

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“…Our study, confirming data from the existing literature (►Table 2), 3,7,9,[13][14][15][16][17] showed that prosthetic reconstruction of the SVC system is a feasible additional procedure during resection of thymic tumor, which infiltrates the venous mediastinal axis minimally increasing postoperative complications in experienced hands. Nevertheless, some points regarding SVC surgery remain controversial, involving optimal procedure, graft size and type, postoperative cares, etc.…”

Section: Discussionsupporting

confidence: 90%

Prosthetic Reconstruction of Superior Vena Cava System for Thymic Tumor: A Retrospective Analysis of 22 Cases

Zhang

Huang

Pan

2020

Thorac Cardiovasc Surg

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Objective This study aimed to report our experience in superior vena cava (SVC) resection and reconstruction for 22 thymic tumor patients and to make comparisons with previous related reports. Methods A retrospective study on 22 patients (15 thymomas, 7 thymic cancers) who underwent tumor resection with concomitant SVC reconstruction. All the patients underwent vascular conduit reconstruction by the cross-clamping technique. The corresponding data were reviewed, including clinical presentation, operation management (surgery procedure, selection of suitable graft, strategies against SVC syndrome, etc.), postoperative cares (antithrombotic agent application, treatments on brain edema, etc.), and follow-up information. Result Two patients were myasthenic, well controlled by oral pyridostigmine. All resections were radical (R0). Ten patients received induction treatment. All the 15 thymoma patients were Masaoka stage III (type B1–B3). As for thymic cancer, six patients were Masaoka stage III and one was stage IVa. Wedge pulmonary resection was performed in three patients (two right upper lobe, one both upper lobe). Procedures included were single graft replacement in 12 patients, bilateral grafts in 9, and Y-shaped graft in 1 patient. Anticoagulation and dehydration agents were routinely applied after operation. No perioperative mortalities were observed. Major complication rate was 9.1%. The median survival time was 44.2 months (range, 4–92 months). Three- and 5-year overall survival rates were 80.8 and 44.0%, respectively. As for conduit patency, two grafts (9.1%) demonstrated evidence of occlusion during long-term follow-up, but no additional interventions were required due to no complications related. Conclusion Our study, confirming data from existing literature, showed that the prosthetic reconstruction of the SVC system is a feasible additional procedure during resection of thymic tumor infiltrating the venous mediastinal axis, minimally increasing postoperative complications in experienced hands.

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Section: Discussionsupporting

confidence: 90%

Prosthetic Reconstruction of Superior Vena Cava System for Thymic Tumor: A Retrospective Analysis of 22 Cases

Zhang

Huang

Pan

2020

Thorac Cardiovasc Surg

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“…Published large-number series providing oncologic outcomes of patients who have undergone extended radical surgery for invasive mediastinal masses are just a few (5,7,8,11,(23)(24)(25). Furthermore, the wide variety of different histologies included in some of these studies (5,7,11,23), as well as the heterogeneity of chemo and radiation therapies employed (7,8), did not allow for the development of clear oncologic guidelines.…”

Section: Commentsmentioning

confidence: 99%

Salvage resection of advanced mediastinal tumors

et al. 2019

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The surgical treatment of locally advanced mediastinal tumors invading the great vessels and other nearby structures still represent a tricky question, principally due to the technical complexity of the resective phase, the contingent need to carry out viable vascular reconstructions and, therefore, the proper management of pathophysiologic issues. Published large-number series providing oncologic outcomes of patients who have undergone extended radical surgery for invasive mediastinal masses are just a few. Furthermore, the wide variety of different histologies included in some of these studies, as well as the heterogeneity of chemo and radiation therapies employed, did not allow for the development of clear oncologic guidelines. Usually in the past, surgical resections of large masses along with the neighbouring structures were not offered to patients because of related morbidity and mortality and limited information available on the prognostic advantage for long term. However, in the last decades, advances in surgical technique and perioperative management, as well as increased oncologic experience in this field, have allowed radical exeresis in selected patients with invasive tumors requiring resections extended to the surrounding structures and complex vascular reconstructions. Such aggressive surgical treatment has been proposed in association or not with adjuvant chemo-or radiotherapy regimens, achieving encouraging oncologic results with limited morbidity and mortality in experienced institutions. Congestive heart failure or impending cardiovascular collapse due to the compression by the large mass are the most frequent immediately lifethreatening problems that some of these patients can experience. In this setting, medical palliation is usually ineffective and an aggressive salvage surgical treatment may remain the only therapeutic option.

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“…Therefore, postoperative brain dysfunction occurs . If the superior vena cava is blocked, the superior vena cava blood flow can be improved to reduce cerebral venous pressure and neurological complications by venous bypass shunting, such as the innominate vein to the right atrial bypass or differential pressure drainage from the internal jugular vein to the femoral vein . However, the innominate vein to right atrial bypass technique is not suitable for patients whose innominate vein is completely invaded by tumor.…”

Section: Introductionmentioning

confidence: 99%

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

Zhang

Tan

et al. 2019

Thoracic Cancer

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Background How to maximally improve the drainage of intracranial and upper body venous and to reduce neurological complications during thoracic tumor‐causedsuperior vena cava replacement are still clinical problems to be solved. Methods We have innovatively used the bilateral jugular vein‐left femoral vein ECMO shunting to perform mediastinal tumor resection and superior vena cava replacement in a 50‐year‐old woman. Results During the operation, this technique maintained the patient's hemodynamic stability, improved the cerebral oxygen saturation and reduced the cerebral ischemia, hypoxia as well as the neurological complications. Conclusion It is indicated for patients with superior vena cava replacement who are unable to perform venous bypass (such as innominate vein to right atrial bypass) or venous shunting (such as differential pressure drainage from internal jugular vein to femoral vein).

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Reconstruction of mediastinal vessels for invasive thymoma: a retrospective analysis of 25 cases

Cited by 27 publications

References 27 publications

Prosthetic Reconstruction of Superior Vena Cava System for Thymic Tumor: A Retrospective Analysis of 22 Cases

Prosthetic Reconstruction of Superior Vena Cava System for Thymic Tumor: A Retrospective Analysis of 22 Cases

Salvage resection of advanced mediastinal tumors

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

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