National Cheng-Kung University Hospital Research Articles

Surgery for malignant involvement of the superior vena cava : W.W. Lai, M.H. Wu, N.S. Chou, M.Y. Lin, Y.L. Tsong. National Cheng-Kung University Hospital, Tainan, Taiwan, R.O.C.

This study reviews surgical operations on seven patients with intrathoracic tumors involving the superior vena cava (SVC). Among these patients, five were found to have advanced bronchogenic carcinoma; one was found to have thyroid carcinoma; and another was found to have thymic carcinoma. The incidence of SVC involvement in resectable lung cancer patients at the National Cheng-Kung University Hospital was 5.8% (5/85). Total excision of SVC was done in three patients and three different prostheses (ringed GoreTex, woven Dacron and pericardial tube graft) were interposed. Four patients underwent partial excision and repair: one by direct suture and three by autologous pericardial patch. A temporary SVC-right atrium internal shunt was used in two of these seven patients. The mean time of SVC cross-clamping in five patients was 20 minutes (10-28 minutes), and the mean value of the central venous pressure at the time of SVC cross-clamping was 34 mmHg (18-54 mmHg). There were no operative deaths or neurologic sequels. Venography or computed tomography obtained 7-100 days after surgery demonstrated all but one to be patent. In conclusion, SVC reconstruction with concomitant tumor resection can be performed if a patient fulfills the following criteria: 1) there is no distant metastasis; 2) a radiosensitive or chemotherapy-effective tumor has been ruled out; and 3) total SVC occlusion or prominent collateral circulation should be avoided.

Esophageal reconstruction for esophageal strictures or resection after corrosive injury

A total of 75 esophageal reconstructions were performed for caustic esophageal strictures (65 patients) or postcaustic resection (10 patients) at Naval General Hospital and National Cheng-Kung University Hospital from September 1976 to April 1991, Reconstructive procedures included bypass in 61 patients, replacement of the esophagus through the substemal route in 10, and replacement of the esophagus through the posterior mediastinum in 4. Esophageal substitutes used for reconstruction were a long segment of the ileum and the ascending colon in 42 patients; a short segment of the ileum and the ascending colon in 18; the ascending colon and transverse colon in 3; the ascending, transverse, and left colon in 1; the transverse and left colon in 6; the jejunum in 2; and the stomach in 3. All but two of the esophageal substitutes were isoperistaltic. There were 28 postoperative complications in 24 (32%) of the 75 patients. Cervical anastomotic leakage occurred in 5 patients (6.7%). There were no operative deaths. Postoperatively, swallow function was considered good in 67 patients (89.3%). In this experience, isoperistaltic transposition of the transverse and left colon provided the best results.