Abstract
BackgroundInvasion of the superior vena cava (SVC) by thoracic tumors and occurrence of SVC syndrome are often encountered in clinical practice; but the prognosis in these cases is poor. Replacement of the SVC with autologous pericardial tissue is rarely performed. In this study, we sought to investigate the postoperative outcomes of this rare procedure.MethodsWe performed a retrospective analysis of six patients who underwent SVC replacement using autologous pericardial tissue between October 2010 and November 2016. We collected data on the patients’ pathological features, operative characteristics, postoperative outcomes, and survival.ResultsAll six patients were male with an average age of 52 years (range, 18–62 years). Three of the patients had lung cancer, one had stage III thymoma, and two had germinoma. Four of the six patients had mild or moderate superior vena cava compression and no corresponding clinical symptoms. The other two patients had severe compression and obvious symptoms of SVC syndrome, with the typical swelling of the face, eyelids, and upper extremities. All six patients underwent complete tumor resection, with two of the lung cancer patients undergoing right lobectomy and one undergoing right pneumonectomy. With respect to the postoperative outcomes, one patient died, whereas the others did not develop any major complications. At the end of the follow-up period, five of the patients were alive and none of the patients had developed thrombosis in the grafts.ConclusionsOur findings indicated that SVC replacement with autologous pericardium is technically feasible and safe, with few postoperative complications and favorable long-term effects. Although it has some limitations, this method appears to be useful in achieving SVC reconstruction of moderate size. SVC replacement with autologous pericardium appears to have the potential for widespread clinical use.
Highlights
Advanced lung or mediastinal tumors sometimes invade the superior vena cava (SVC), and surgery for such invasive lesions is still controversial because of the poor prognosis [1, 2]
In five of the six cases, SVC reconstruction was performed using the SVC clamp technique; the average duration of SVC clamping in these cases was 77 min
Postoperative thoracic spiral computed tomography (CT) with 3D reconstruction was performed in all cases, and uninterrupted flow and adequate filling of the SVC were noted in all cases (Fig. 7)
Summary
Advanced lung or mediastinal tumors sometimes invade the superior vena cava (SVC), and surgery for such invasive lesions is still controversial because of the poor prognosis [1, 2]. Advanced lung or primary mediastinal malignancies are the most common causes of SVC syndrome, accounting for 60% of the cases [3]. Surgical treatment for the management of lung cancer or mediastinal malignancy invading the SVC involves the replacement of the SVC. The use of autologous tissue, the pericardium, is less common and challenging in a clinical setting, especially when performed by surgeons who lack relevant experience [5]. Invasion of the superior vena cava (SVC) by thoracic tumors and occurrence of SVC syndrome are often encountered in clinical practice; but the prognosis in these cases is poor. We sought to investigate the postoperative outcomes of this rare procedure
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