The purpose of this retrospective study was to investigate long-term graft patency and outcomes for malignant diseases.
From October 1995 to November 2008, twenty patients underwent combined surgical resection of malignant tumors and the superior vena cava with vascular reconstruction using ringed polytetrafluoroethylene (PTFE) graft at three thoracic surgical centers. Sigmoid-curved cutting of the graft-end at right auricle side was performed for obtaining wide opening of a left graft in bilateral graft patients. Anti-coagulation therapy was routinely performed for at least three months. Graft patency was verified by venography or contrast-enhanced computed tomography at two to four weeks and 3 months after operation. Ten patients were lung cancer, eight were thymic cancer or invasive thymoma (with myasthenia gravis in four patients) and two were germ cell tumors.
Nine patients received single graft replacement, ten received bilateral, and one received bilateral SVC grafts and one pulmonary artery graft. All grafts were patent at short-term periods, but one of the two grafts experienced occlusion in two bilateral graft patients at long-term period. Postoperative temporary facial edema was identified in three patients who received single graft, but no facial edema was identified in patients with bilateral grafts. One in-hospital death was identified due to bronchial dehiscence in lung cancer. Mean follow-up was 44.7 months. Median survival was 22.1 months and overall survival was 66.4% and 41.5% at one and five years, respectively. Lung cancer was significantly worse long term survival than the other two groups Five year survivals were 16.7% in lung cancer, 62.5% in thymic tumor and 100% in germ cell tumors (p=0.024). Only two out of eight lung cancer patients with nodal involvement survived.
Both single and double reconstructions are feasible and effective treatment for invasive malignant diseases. However, indication of SVC reconstruction for lung cancer should be carefully considered in patients with nodal involvements.
SVC reconstruction can be performed with low mortality and graft occlusion for effective treatment of mediastinal malignancies.
Yasuo Sekine, No Financial Disclosure Information; No Product/Research Disclosure Information