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Major vascular reconstructions in thoracic oncological surgery
Leonardo Duranti1, Luca Tavecchio2
1Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Via Venezian 1, 20133, Milan, Italy. leonardo.duranti@istitutotumori.mi.it.
Updates in Surgery
|February 29, 2024
Summary
This study shows that major thoracic oncological vascular surgery, including superior vena cava and pulmonary artery reconstruction, is safe and feasible. Optimal outcomes depend on appropriate early anticoagulant or antiplatelet therapy to ensure graft patency and prevent complications.
Area of Science:
- Cardiovascular Surgery
- Thoracic Oncology
- Vascular Reconstruction
Background:
- Radical oncological surgery for thoracic malignancies may necessitate resection and reconstruction of the superior vena cava (SVC) and thoracic outlet vessels.
- Pulmonary artery involvement by tumor or metastatic lymph nodes can require resection and reconstruction to achieve oncological goals or avoid pneumonectomy.
Purpose of the Study:
- To evaluate the safety and feasibility of major thoracic oncological vascular surgery.
- To assess the role of early anticoagulant and antiplatelet therapy in maintaining graft patency and preventing complications.
Main Methods:
- Retrospective review of 41 patients undergoing SVC, thoracic outlet vessel, or pulmonary artery reconstruction by a single surgeon between 2017 and 2023.
- Analysis of early anticoagulant therapy in SVC/thoracic outlet vessel bypass patients and early antiaggregation therapy in pulmonary artery reconstruction patients.
Main Results:
- Fourteen patients underwent SVC/thoracic outlet vessel procedures with one death (respiratory failure) and one graft closure due to coagulopathy.
- Twenty-seven patients underwent pulmonary artery reconstruction with one bleeding event requiring re-operation.
- Early anticoagulant/antiplatelet therapy was crucial for graft patency and complication prevention.
Conclusions:
- Major thoracic oncological vascular surgery is safe and feasible with skilled surgical technique.
- Integration of appropriate early anticoagulant or antiplatelet therapy is essential for optimal results, maintaining bypass/graft patency, and mitigating risks.
