Combined tracheal sleeve and superior vena cava resections for non-small cell lung cancer

Combined superior vena cava and tracheal sleeve resections are occasionally indicated in the treatment of non-small cell lung cancer. However, more effective induction therapy may potentially expand the benefit of locally extended resections.

From January 1998 to December 1999, 6 consecutive patients had combined tracheal sleeve and superior vena cava resections for non-small cell lung cancer after induction treatment. Surgical approach was muscle-sparing lateral thoracotomy in 4 patients and hemiclam-shell approach in 2 patients. There were four tracheal sleeve pneumonectomies, one tracheal sleeve bilobectomy, and one tracheal sleeve lobectomy. Three patients (50%) had complete superior vena cava resection with graft replacement, whereas the other patients had partial superior vena cava resection using vascular staplers.

There were no perioperative complications. Three patients (50%) had major postoperative complications, but there were no postoperative deaths. Four patients are still alive, 2 without evidence of disease. The median survival was 14.5 months (range, 3 to 17 months).

These combined resections are technically feasible with no postoperative mortality but high morbidity (50%). This aggressive surgery may be useful in highly selected patients where adequate local control can achieve long-term survival.