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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2008 February;21(1):1-4
Resection and prosthetic reconstruction of superior vena cava for non-small cell advanced lung cancer patients
Yamamoto S., Shirakusa T., Kawahara K., Shiraishi T., Iwasaki A.
Second Department of Surgery Fukuoka University School of Medicine Fukuoka, Japan
Aim. The purpose of this study is to evaluate our experience and discuss about the indication of surgery for advanced non-small cell lung cancer patients.
Methods. From 1994 to 2002, ten non-small cell lung cancer patients with superior vena cava (SVC) invasion underwent lung resection and SVC prosthetic reconstruction. Induction chemo-radiation therapy was performed for one patient, the regimen is 40Gy irradiation therapy and concurrent low dose CDDP (10mg/body/day) + 5-FU (250mg/body/day) for 4 weeks. One another patient had induction irradiation therapy of 50Gy.
Results. Lung lobectomies were performed for nine patients, in those three patients were performed lung lobectomy with carinal resection, two patients were performed lung lobectomy with bronchoplasty. One another patient was performed right sleeve pneumonectomy. Bilateral vein reconstructions were performed for eight patients, and unilateral vein reconstructions were performed for two patients. All bilateral reconstructions were performed from the right atrium to left innominate vein first, and then proximal SVC to right innominate vein anastomosis using ringed expanded polytetrafluoloethyrene (PTFE) vascular graft (10 or 12 mm in diameter). There was no patient with re-operation due to massive bleeding or thrombosis in the grafts. Fifteen of the eighteen (83.0%) graft anastomosis were patent. Three patients died within 30 days postoperatively. Two patients are well alive without malignancy, five patients died with lung cancer recurrence after 180-845 post-operative days.
Conclusion. Although prognosis of combined resection of SVC is generally unfavorable, however it is considered that SVC replacement for the NSCLC patients is not always absolute contraindication. We would like to emphasize that the possibility of complete resection of tumor is the most important factor of the prognosis.