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Right arrow Lung - cancer

Ann Thorac Surg 2007;83:223-230
© 2007 The Society of Thoracic Surgeons

Original Articles: General Thoracic

Superior Vena Cava Resection for Lung and Mediastinal Malignancies: A Single-Center Experience With 70 Cases

Lorenzo Spaggiari, MD, PhDa,b,c,*, Francesco Leo, MD, PhDa,c, Giulia Veronesi, MDa,c, Piergiorgio Solli, MDa,c, Domenico Galetta, MDa,c, Brunilda Tatani, MDa,c, Francesco Petrella, MDa,c, Davide Radice, PhDb,c

a Division of Thoracic Surgery, European Institute of Oncology, University of Milan School of Medicine, Milan, Italy
c Division of Epidemiology, European Institute of Oncology, University of Milan School of Medicine, Milan, Italy
b Division of Biostatistics, European Institute of Oncology, University of Milan School of Medicine, Milan, Italy

Accepted for publication July 27, 2006.

* Address correspondence to Dr Spaggiari, Department of Thoracic Surgery, European Institute of Oncology, via Ripamonti 435, 20141 Milan, Italy (Email: lorenzo.spaggiari{at}ieo.it).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

BACKGROUND: The oncologic value of superior vena cava (SVC) resection for lung and mediastinal malignancies remains controversial. In this context, we have reviewed our experience in the treatment of locally advanced lung and mediastinal tumor invading the SVC system, analyzing postoperative outcome and long-term oncologic results.

METHODS: The clinical data of patients who underwent SVC resection were retrospectively analyzed to assess postoperative mortality, and overall and procedure-specific morbidity. Overall survival was calculated for mediastinal and lung tumor groups.

RESULTS: From 1998 to 2004, 70 consecutive patients (52 with lung cancer and 18 with mediastinal tumors) underwent SVC system resection. There were 25 replacements (36%) of the SVC system by prosthesis, whereas the remaining underwent partial resection. Major postoperative morbidity and mortality rates in lung cancer patients were 23% and 7.7%, respectively (50% and 5.6% in mediastinal tumors). In the lung cancer group, 5-year survival probability was 31%, and it was affected by mediastinal nodal status (5-year survival in N0–N1 patients 52%, 21% in N2 patients, 0 in N3 patients). Median survival for mediastinal tumors was 49 months.

CONCLUSIONS: In conclusion, SVC resection may achieve permanent cure in patients who would have been defined as inoperable 10 years ago. In the case of mediastinal tumors, the need for SVC resection alone should not be considered a contraindication for surgery when prosthetic replacement is feasible. In the case of lung tumors, infiltration of SVC can achieve satisfactory long-term results after neoadjuvant chemotherapy, only when pathologic N2 disease is excluded by preoperative mediastinoscopy.




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