Reconstruction of the superior vena cava in patients with thymic malignancies.

Abstract

e21116 Background: Thymoma is a kind of mediastinal tumors usually with an indolent growth pattern but malignant because of potential for local invasion, pleural dissemination, and even systemic metastases. Different from other malignant tumors, thymoma is often associated with autoimmune disorder s, the most common one being myasthenia gravis (MG). Complete surgical excision has been regarded as the standard of care for patients with thymoma, esp. locally advanced thymoma. The aim of this study was to investigate the effectiveness of reconstruction (Y-shaped bypass) of the superior vena cava (SVC) to treat locally advanced thymoma with SVC syndrome. Methods: We retrospectively studied data from 24 consecutive patients with locally advanced thymoma and SVC syndrome, operated on from October. 2015 to Dec. 2018 in Beijing Tongren Hospital. Their clinical data including clinical presentation, operation procedure, postoperative drug, adjuvant radiochemotherapy and follow-up were documented. 18 cases had MG, one having dermatomyositis, and two having interstitial pneumonia. Results: There were no perioperative deaths. All patients underwent complete resection and replacement with a GORE-TEX Vascular Graft (Y-shaped bypass) of SVC. The number of typeAB, B1, B2, B3 thymoma, and thymic carcinoma in this data were 2, 2, 7, 7, and 6, respectively. 7 patients had postoperative complications: 3 (with MG) experienced myasthenia crisis, 3 had pneumonia, and one had pulmonary embolisms, respectively. Both unfractionated heparin and Warfarin were routinely used the second or third day after surgery to maintain INR (International Normalized Ratio) between 1.8 and 2.5. All patients received mediastinal radiation therapy within one month after surgery. All patients were followed up for 2 months to 42 months. There were no patients dying and recurring. Conclusions: Reconstruction of SVC (Y-shaped bypass) is an effective way to treat locally advanced thymoma with SVC syndrome. After surgery, postoperative anti-thrombotic agents should be applied to prevent acute graft occlusion.