Surgery for malignant involvement of the superior vena cava

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.