Prosthetic reconstruction of the superior vena cava for malignant disease: surgical techniques and outcomes

This retrospective study investigated long-term graft patency and outcomes for malignant diseases with invasion of the superior vena cava (SVC).

From October 1995 to November 2008, 20 patients underwent combined surgical resection of malignant tumors and the SVC with vascular reconstruction using a ringed polytetrafluoroethylene graft (8 to 12 mm) Sigmoid-curved spatulation of the graft end at the right auricle was performed to obtain a wide orifice left graft. Anticoagulation therapy was routinely administered for 3 to 6 months. Postoperative graft patency was verified at 2 to 4 weeks, 3 months, and after 12 months. Indications were lung cancer in 9 patients, thymic tumors in 8, germ cell tumors in 2, and thyroid cancer in 1.

Procedures were single graft replacement in 9 patients, bilateral grafts in 10, and bilateral SVC grafts and 1 pulmonary artery graft in 1. All grafts were patent over a short-term period, but 1 limb of the bilateral grafts became occluded in 2 patients who received bilateral grafts during long-term follow-up. Bronchial dehiscence after lung cancer resection caused 1 in-hospital death. Mean follow-up was 44.7 months. Median survival was 22.1 months. Overall survival was 66.4% and 41.5% at 1 and 5 years, respectively. Survival for lung cancer was significantly worse at 5 years (62.5%) than thymic tumor (18.8%, p = 0.04).

Prosthetic reconstruction of the SVC for anterior mediastinal tumors and lung cancer is feasible. Reconstruction of the SVC using a single left graft to avoid total cross-clamping of the SVC is effective.