Superior Vena Cava Replacement for Thymic Malignancies

Maurizi, Giulio; Poggi, Camilla; D’Andrilli, Antonio; Vanni, Camilla; Ciccone, Anna Maria; Ibrahim, Mohsen; Andreetti, Claudio; Tierno, Simone Maria; Venuta, Federico; Rendina, Erino Angelo

doi:10.1016/j.athoracsur.2018.08.060

Cited by 40 publications

(42 citation statements)

References 27 publications

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“…13,19 In bilateral graft cases, besides smaller size, attention needs to be paid on the matches of diameter of both graft vessels, preventing the occurrence of blood stealing, which could result in blood flow reduction in the small vessel and even thrombus formation. 20,21 Our experience for bilateral reconstruction is that the artificial vessel in 1.2 to 1.4 cm diameter is suitable to replace right BCVor SVC, and 1.0 to 1.2 cm fitting for left BCV. In addition, the diameter difference between the two grafts should be within 0.4 cm.…”

Section: Surgery Procedures Recommended and Grafts Selectedmentioning

confidence: 99%

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: Surgery Procedures Recommended and Grafts Selectedmentioning

confidence: 99%

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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“…Intraoperative and postoperative heparinization is mandatory to avoid thrombotic complications. According to the extent of the vascular involvement, the SVC reconstruction can be performed by tangential resection and direct suture or interposition of an autologous or bovine pericardial patch, but the most common procedure is the replacement with a prosthetic conduit, usually in PTFE or autologous/bovine pericardium (10,11). When the confluence of the innominate veins is infiltrated by the tumor, the preference is to revascularize only one innominate vein, usually the left (12).…”

Section: Svcmentioning

confidence: 99%

Surgical treatment for locally advanced lung cancer involving the heart and great vessels: a mini-review

Argento¹,

Rendina²,

Maurizi³

2020

Curr Chall Thorac Surg

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Currently, there is no unanimous agreement about the indications of surgical treatment for locally advanced lung cancer, particularly when the heart and the great vessels are involved. Though generally not considered indicated in this cases, surgery can be offered to highly selected patients when a radical resection is considered achievable, and neither distant nor nodal metastasis are present. Throughout the last few decades, many authors have explored the possibility for surgical resection of lung cancer involving the heart and/or the great vessels [thoracic aorta, pulmonary artery, superior vena cava (SVC)]. In this article we consider their experiences focusing on the technical aspects of the vascular reconstruction.

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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%

“…Our recent homogenous case series (25) including only patients undergoing SVC conduit replacement for thymoma or thymic carcinoma (n=27; 21 thymoma, 6 thymic carcinoma) reports results after vascular reconstruction always performed by the cross-clamping technique. Twelve patients had undergone previous oncology treatment.…”

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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Superior Vena Cava Replacement for Thymic Malignancies

Cited by 40 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

Surgical treatment for locally advanced lung cancer involving the heart and great vessels: a mini-review

Salvage resection of advanced mediastinal tumors

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