Complete superior vena cava resection for invasive thymoma

Abstract

: Thymoma is the most common primary mediastinal tumour. It has the potential to invade mediastinal structures and requires complex surgical resection to gain clearance. We present the surgical technique for resection of a thymoma invading the superior vena cava (SVC). Our patient was a 58-year-old man with an anterior mediastinal mass. Computerized tomography (CT) scan showed a 55 mm mass invading the SVC. Histology from a CT-guided biopsy showed a B2 thymoma. Median sternotomy was performed and the thymoma was confirmed to be invading the SVC. The tumour extended superiorly to partially invade the left and right brachiocephalic veins. Additionally, it was infiltrating the right upper lobe, pericardium, and right phrenic nerve. We constructed a venous graft with a GORE-TEX vascular graft from the left brachiocephalic vein to the right atrium. This was followed by en bloc resection of the thymus and SVC with parts of the left and right brachiocephalic veins, along with a wedge resection of the right upper lobe, pericardium, and right phrenic nerve. The patient recovered well, and some initial facial oedema had resolved at his four-week follow-up appointment. Histology confirmed B2 thymoma with a clear resection margin.