Combined tracheal sleeve and superior vena cava resections for non–small cell lung cancer

Abstract

Background. Combined superior vena cava and tracheal sleeve resections are occasionally indicated in the treatment of non–small cell lung cancer. However, more effective induction therapy may potentially expand the benefit of locally extended resections. Methods. From January 1998 to December 1999, 6 consecutive patients had combined tracheal sleeve and superior vena cava resections for non–small cell lung cancer after induction treatment. Surgical approach was muscle-sparing lateral thoracotomy in 4 patients and hemiclamshell approach in 2 patients. There were four tracheal sleeve pneumonectomies, one tracheal sleeve bilobectomy, and one tracheal sleeve lobectomy. Three patients (50%) had complete superior vena cava resection with graft replacement, whereas the other patients had partial superior vena cava resection using vascular staplers. Results. There were no perioperative complications. Three patients (50%) had major postoperative complications, but there were no postoperative deaths. Four patients are still alive, 2 without evidence of disease. The median survival was 14.5 months (range, 3 to 17 months). Conclusions. These combined resections are technically feasible with no postoperative mortality but high morbidity (50%). This aggressive surgery may be useful in highly selected patients where adequate local control can achieve long-term survival.