[Surgical diagnostic procedures in superior vena cava syndrome]

We evaluate surgical risk and efficacy in a series of 29 patients referred to us over a 22-year period with diagnoses of superior vena cava syndrome (SVCS) requiring surgical removal of histology specimens. We did 34 procedures: 23 mediastinoscopies, 6 mediastinotomies, 2 thoracotomies, 2 sternotomies and 1 Daniel's biopsy procedure. Mean surgical time was 88 minutes. There were no serious surgical complications and no deaths. Histological diagnoses (27 malignant and 2 benign) were obtained for all patients. The efficacy of mediastinoscopy was 82.6% whereas the efficacy of mediastinotomy was 66.6%. We believe that diagnostic surgical procedures in patients with SVCS are safe and effective. The use of blind radiation therapy is unjustified, given that some patients present benign processes or malignant ones that are more responsive to chemotherapy. Moreover, subsequent histologic confirmation can be made more difficult after blind radiation.