Results of superior vena cava resection in patients with lung and mediastinal tumors

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Background: Thoracic tumors involving the superior vena cava (SVC) are common in the practice of a thoracic surgeon treating cancer patients. Extended combined procedures that allow for complete removal of the tumor improves overall and disease-free survival and as such are justified from an oncologist’s perspective. In some patients, due to a long-standing SVC syndrome, the development of venous collaterals would increase the early postoperative risk of thrombus formation in the prosthesis. In such a case, it is possible to perform circular SVC resection without subsequent prosthetic replacement. 

Aim: To evaluate the short-term results of SVC resection in patients with chest tumors, to develop an algorithm and to identify the patient group in whom circular SVC without prosthetic replacement is feasible.

 Materials and methods: Twenty eight (28) patients were included into the study (22 men and 6 women, with the mean age of 55 [range, 21 to 70 years]; all of them had undergone SVC resection within the intervention for a lung or mediastinal malignancy for 10 years (from 2008 to 2018) in the Department of Thoracic Surgery, Moscow Research Institute of Oncology named after P.A. Herzen. We analyzed their short-term results of the procedures, the postoperative course, and technical particulars of the procedures. 

Results: Locally advanced lung cancer was diagnosed in 19 (67%) of the patients, thymoma in 3 (10%), lung metastatic disease in 2 (7%), germ-cell mediastinal tumors in 2 (7%), thymus cancer in 1 (3%), and residual lymphoma in 1 (3%) patient. In the majority of the patients (15 cases, 53%), the complicated clinical course had been diagnosed before surgery. In 4 patients with protracted SVC syndrome, we performed circular resection without any prosthetic replacement. In 22 patients (78%), the postoperative course was uneventful. Postoperative mortality was 7%. 

Conclusion: SVC resection can be safely performed in patients with primary mediastinal and lung tumors. With a long-standing SVC syndrome, the newly developed cava-caval anastomoses can provide significant functional support; in such patients with compensatory collateral blood flow, the circular SVC resection without prosthetic replacement is relatively safe.

About the authors

O. A. Alexandrov

Р. Herzen Moscow Oncology Research Institute – Branch of the National Medical Research radiological Centre

Author for correspondence.
ORCID iD: 0000-0002-4131-9179

Oleg A. Alexandrov – Junior Research Fellow, Department of Thoracic Surgery

3 2nd Botkinskiy proezd, Moscow, 125284, Russian Federation

Russian Federation

O. V. Pikin

Р. Herzen Moscow Oncology Research Institute – Branch of the National Medical Research radiological Centre

ORCID iD: 0000-0001-6871-6804

Oleg V. Pikin – MD, PhD, Head of Department of Thoracic Surgery

3 2nd Botkinskiy proezd, Moscow, 125284, Russian Federation

Russian Federation

A. B. Ryabov

Р. Herzen Moscow Oncology Research Institute – Branch of the National Medical Research radiological Centre

ORCID iD: 0000-0002-1037-2364

Andrey B. Ryabov – MD, PhD, Head of Department of Thoracoabdominal Oncosurgery

3 2nd Botkinskiy proezd, Moscow, 125284, Russian Federation

Russian Federation


  1. Danias PG, Pipilis AG. Superior vena cava syndrome: 1757-2007. Hellenic J Cardiol. 2007;48(6):366–7.
  2. Spaggiari L, Leo F, Veronesi G, Solli P, Galetta D, Tatani B, Petrella F, Radice D. Superior vena cava resection for lung and mediastinal malignancies: a single-center experience with 70 cases. Ann Thorac Surg. 2007;83(1):223–9. doi: 10.1016/j.athoracsur.2006.07.075.
  3. Wilson LD, Detterbeck FC, Yahalom J. Clinical practice. Superior vena cava syndrome with malignant causes. N Engl J Med. 2007;356(18): 1862–9. doi: 10.1056/NEJMcp067190.
  4. Venuta F, Rendina EA. Superior vena cava resection and reconstruction. Eur J Cardiothorac Surg. 2012;41(5):1177–8. doi: 10.1093/ejcts/ezr266.
  5. Jones DR. Technique of superior vena cava resection for lung carcinomas. Oper Tech Thorac Cardiovasc Surg. 2008;13(4):274–82. doi: 10.1053/j.optechstcvs.2009.01.002.
  6. Cohen DJ, Ronnigen LD, Graeber GM, Deshong JL, Jaffin J, Burge JR, Zajtchuk R. Management of patients with malignant thymoma. J Thorac Cardiovasc Surg. 1984;87(2): 301–7.
  7. Inaco Cirino LM, Ferreira Coelho R, Dias da Rocha I, Pinheiro de Senna Nogueira Batista B. Treatment of superior vena cava syndrome. J. Bras. Pneumol. 2005;31(6). doi: 10.1590/S180637132005000600013.
  8. Lazzarino M, Orlandi E, Paulli M, Boveri E, Morra E, Brusamolino E, Kindl S, Rosso R, Astori C, Buonanno MC. Primary mediastinal B-cell lymphoma with sclerosis: an aggressive tumor with distinctive clinical and pathologic features. J Clin Oncol. 1993;11(12):2306–13. doi: 10.1200/JCO.1993.11.12.2306.
  9. Perez-Soler R, McLaughlin P, Velasquez WS, Hagemeister FB, Zornoza J, Manning JT, Fuller LM, Cabanillas F. Clinical features and results of management of superior vena cava syndrome secondary to lymphoma. J Clin Oncol. 1984;2(4):260–6. doi: 10.1200/JCO.1984.2.4.260.
  10. Holbert BL, Libshitz HI. Superior vena caval syndrome in primary mediastinal germ cell tumors. Can Assoc Radiol J. 1986;37(3):182–3.
  11. Rowell NP, Gleeson FV. Steroids, radiotherapy, chemotherapy and stents for superior vena caval obstruction in carcinoma of the bronchus: a systematic review. Clin Oncol (R Coll Radiol). 2002;14(5):338–51. doi: 10.1053/clon.2002.0095.
  12. Yagi K, Hirata T, Fukuse T, Yokomise H, Inui K, Ike O, Mizuno H, Aoki M, Hitomi S, Wada H. Surgical treatment for invasive thymoma, especially when the superior vena cava is invaded. Ann Thorac Surg. 1996;61(2):521–4. doi: 10.1016/0003-4975(95)00983-3.
  13. Пикин ОВ, Трахтенберг АХ, Колбанов КИ, Глушко ВА, Казакевич ВИ, Амиралиев АМ, Вурсол ДА, Кирсанова ОН. Циркулярная резекция верхней полой вены без протезирования у больных с опухолью средостения, осложненной синдромом медиастинальной компрессии. Онкохирургия. 2013;5(2): 60–6.
  14. Spaggiari L, Thomas P, Magdeleinat P, Kondo H, Rollet G, Regnard JF, Tsuchiya R, Pastorino U. Superior vena cava resection with prosthetic replacement for non-small cell lung cancer: long-term results of a multicentric study. Eur J Cardiothorac Surg. 2002;21(6): 1080–6. doi: 10.1016/s1010-7940(02)00175-6.
  15. Александров ОА, Рябов АБ, Пикин ОВ. Тимома (обзор литературы). Сибирский онкологический журнал. 2017;16(4):76–83. doi: 10.21294/1814-4861-2017-16-4-76-83.
  16. Fujisawa T, Yamaguchi Y, Baba M, Shiba M, Yamakawa H, Kimura H, Ogawa T, Kadoyama C, Yusa T, Iwai N. [Significance of superior vena cava reconstruction with EPTFE grafts in the surgical treatment of superior and anterior mediastinal invasive malignant tumors]. Nihon Kyobu Shikkan Gakkai Zasshi. 1990;28(4): 612–6. Japanese.
  17. Scherck JP, Kerstein MD, Stansel HC Jr. The current status of vena caval replacement. Surgery. 1974;76(2):209–33.
  18. Spaggiari L, Magdeleinat P, Kondo H, Thomas P, Leon ME, Rollet G, Regnard JF, Tsuchiya R, Pastorino U. Results of superior vena cava resection for lung cancer. Analysis of prognostic factors. Lung Cancer. 2004;44(3):339–46. doi: 10.1016/j.lungcan.2003.11.010.
  19. Dartevelle PG, Chapelier AR, Pastorino U, Corbi P, Lenot B, Cerrina J, Bavoux EA, Verley JM, Neveux JY. Long-term follow-up after prosthetic replacement of the superior vena cava combined with resection of mediastinal-pulmonary malignant tumors. J Thorac Cardiovasc Surg. 1991;102(2):259–65.
  20. Lee GD, Kim HR, Choi SH, Kim YH, Kim DK, Park SI. Prosthetic graft interposition of the brachiocephalic veins or superior vena cava combined with resection of malignant tumours: graft patency and risk factors for graft occlusion. J Thorac Dis. 2016;8(1):61–7. doi: 10.3978/j.issn.2072-1439.2016.01.07.
  21. Shintani Y, Ohta M, Minami M, Shiono H, Hirabayashi H, Inoue M, Matsumiya G, Matsuda H. Long-term graft patency after replacement of the brachiocephalic veins combined with resection of mediastinal tumors. J Thorac Cardiovasc Surg. 2005;129(4):809–12. doi: 10.1016/j.jtcvs.2004.05.001.
  22. Okereke IC, Kesler KA, Rieger KM, Birdas TJ, Mi D, Turrentine MW, Brown JW. Results of superior vena cava reconstruction with externally stented-polytetrafluoroethylene vascular prostheses. Ann Thorac Surg. 2010;90(2):383– 7. doi: 10.1016/j.athoracsur.2010.04.004.

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Copyright (c) 2019 Alexandrov O.A., Pikin O.V., Ryabov A.B.

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