Application of vascular repair and reconstruction in surgical treatment of superior vena cava syndrome caused by thoracic tumor_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANGZhenlong ¹ ,  PANXiaojie ¹ , QIUHanfan ² , GUOTianxing ¹ , OUDebin ¹ , DINGHang ¹

1. Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou Fujian 350001, P.R.China;
2. Department of Cardiac Surgery, the Affiliated Union Hospital, Fujian Medical University, Fuzhou Fujian, 350001, P.R.China;

Corresponding?author：

PANXiaojie, Email: pxj1028@hotmail.com

Keywords：

Superior vena cava syndrome; thoracic tumor; vascular repair and reconstruction

DOI：

10.7507/1002-1892.201610036

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Objective To summarize the clinical experience of vascular repair and reconstruction for treating superior vena cava syndrome (SVCS) caused by thoracic tumor. Methods Between October 2008 and June 2016, 26 patients with thoracic tumor and SVCS were admitted. There were 18 males and 8 females, aged from 27 to 70 years (mean, 45.9 years). Tumor was typed as B1-B3 thymoma in 13 cases, thymic carcinoma in 6 cases, large B-cell lymphoma in 3 cases, T lymphocytic lymphoma in 1 case, malignant teratoma in 1 case, right lung squamous cell carcinoma in 1 case, and carcinoid in 1 case. The tumor diameter ranged from 8 to 15 cm with an average of 10 cm. The patients had different degrees of neck, face, and upper extremity edema, jugular vein distention, and chest wall collateral venous filling. The superior vena cava pressure was 2.45-5.39 kPa. After excision of tumor and invading superior vena cava, 7 patients underwent superior vena cava reconstruction and 19 patients underwent artificial vascular replacement. Results There was no perioperative death, and the symptoms of superior vena cava obstruction were eliminated. Postoperative pulmonary infection, respiratory muscle weakness, and right chylothorax occurred in 4 cases, 1 case, and 1 case respectively. Twenty-four patients were followed up 2-92 months (mean, 37 months), and 2 patients failed to be followed up. At 1, 3, and 5 years, the survival rate was 83.3% (20/24), 41.7% (10/24), and 25% (6/24), respectively. In 6 patients with 5-year survival, there were 1 case of type B1 thymoma, 3 cases of type B3 thymoma, and 2 cases of large B-cell lymphoma. Conclusion For preoperative evaluation of SVCS caused by resectable thoracic tumors, vascular repair and recons-truction technique can be used to quickly and effectively relieve the clinical symptoms and improve the quality of life.

Citation： ZHANGZhenlong, PANXiaojie, QIUHanfan, GUOTianxing, OUDebin, DINGHang. Application of vascular repair and reconstruction in surgical treatment of superior vena cava syndrome caused by thoracic tumor. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(2): 231-234. doi: 10.7507/1002-1892.201610036 Copy

1.	楊永波, 尤嘉琮, 周清華. 胸部腫瘤引起的上腔靜脈綜合征的外科治療. 中國肺癌雜志, 2009, 12(9): 1018-1021.
2.	Chan RC, Chan YC, Cheng SW. Mid- and long-term follow-up experience in patients with malignant superior vena cava obstruction. Interact Cardiovasc Thorac Surg, 2013, 16(4): 455-458.
3.	謝亮, 陳剛, 鄧澄, 等. 累及心臟大血管的復雜縱隔腫瘤的臨床外科處理. 中國胸心血管外科臨床雜志, 2016, 23(1): 38-43.
4.	Picquet J, Blin V, Dussaussoy C, et al. Surgical reconstruction of the superior vena cava system: indications and results. Surgery, 2009, 145(1): 93-99.
5.	彭忠民, 陳景寒, 孟龍, 等. 肺癌累及上腔靜脈的外科治療. 中華外科雜志, 2006, 44(6): 402-404.
6.	Motus IY, Bazhenov AV, Massard G. Surgery for huge mediastinal tumors. Asian Cardiovasc Thorac Ann, 2015, 23(7): 846-850.
7.	王振捷, 于洪泉, 任華, 等. 上腔靜脈和無名靜脈的切除及重建治療縱隔腫瘤.中國胸心血管外科雜志, 2005, 12(1): 22-25.
8.	Sekine Y, Suzuki H, Saitoh Y, et al. Prosthetic reconstruction of the superior vena cava for malignant disease: surgical techniques and outcomes. Ann Thorac Surg, 2010, 90(1): 223-228.
9.	Ried M, Potzger T, Sziklavari Z, et al. Extended surgical resections of advanced thymoma Masaoka stages III and IVa facilitate outcome. Thorac Cardiovasc Surg, 2014, 62(2): 161-168.
10.	Politi L, Crisci C, Montinaro F, et al. Prosthetic replacement and tangential resection of the superior vena cava in chest tumors. J Cardiovasc Surg (Torino), 2007, 48(3): 363-368.
11.	梁恒星, 劉文亮, 王翔, 等. 惡性胸腺瘤侵犯大血管的手術治療及術后生存調查. 中國現代手術學雜志, 2013, 17(2): 142-147.
12.	Kawamukai K, Anotonacci F, Di Saverio S, et al. Acute postoperative cardiac herniation. Interact Cardiovasc Thorac Surg, 2011, 12(1): 73-74.
13.	周清華. 局部晚期肺癌擴大性手術的應用指征及進展. 中國癌癥雜志, 2003, 13(5): 411-415.
14.	Ried M, Neu R, Schalke B, et al. Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support. J Cardiothorac Surg, 2015l, 10: 137.
15.	Arif R, Eichhorn F, Kallenbach K, et al. Resection of thoracic malignancies infiltrating cardiac structures with use of cardiopulmonary bypass. J Cardiothorac Surg, 2015, 10: 87.
16.	Garcia A, Flores RM. Surgical management of tumors invading the superior vena cava. Ann Thorac Surg, 2008, 85(6): 2144-2146.
17.	Kim D, Kim SW, Hong JM. Rapid growing huge teratoma: complete surgical resection. J Thorac Dis, 2014, 6(10): E217-E219.
18.	Lee DS, Flores RM. Superior vena caval resection in lung cancer. Thorac Surg Clin, 2014, 24(4): 441-447.
19.	Okereke IC, Kesler KA, Rieger KM, et al. Results of superior vena cava reconstruction with externally stented-polytetrafluoroethylene vascular prostheses. Ann Thorac Surg, 2010, 90(2): 383-387.
20.	Lee GD, Kim HR, Choi SH, et al. Prosthetic graft interposition of the brachiocephalic veins or superior vena cava combined with resection of malignant tumours: graft patency and risk factors for graft occlusion. J Thorac Dis, 2016, 8(1): 61-67.

1. 楊永波, 尤嘉琮, 周清華. 胸部腫瘤引起的上腔靜脈綜合征的外科治療. 中國肺癌雜志, 2009, 12(9): 1018-1021.
2. Chan RC, Chan YC, Cheng SW. Mid- and long-term follow-up experience in patients with malignant superior vena cava obstruction. Interact Cardiovasc Thorac Surg, 2013, 16(4): 455-458.
3. 謝亮, 陳剛, 鄧澄, 等. 累及心臟大血管的復雜縱隔腫瘤的臨床外科處理. 中國胸心血管外科臨床雜志, 2016, 23(1): 38-43.
4. Picquet J, Blin V, Dussaussoy C, et al. Surgical reconstruction of the superior vena cava system: indications and results. Surgery, 2009, 145(1): 93-99.
5. 彭忠民, 陳景寒, 孟龍, 等. 肺癌累及上腔靜脈的外科治療. 中華外科雜志, 2006, 44(6): 402-404.
6. Motus IY, Bazhenov AV, Massard G. Surgery for huge mediastinal tumors. Asian Cardiovasc Thorac Ann, 2015, 23(7): 846-850.
7. 王振捷, 于洪泉, 任華, 等. 上腔靜脈和無名靜脈的切除及重建治療縱隔腫瘤.中國胸心血管外科雜志, 2005, 12(1): 22-25.
8. Sekine Y, Suzuki H, Saitoh Y, et al. Prosthetic reconstruction of the superior vena cava for malignant disease: surgical techniques and outcomes. Ann Thorac Surg, 2010, 90(1): 223-228.
9. Ried M, Potzger T, Sziklavari Z, et al. Extended surgical resections of advanced thymoma Masaoka stages III and IVa facilitate outcome. Thorac Cardiovasc Surg, 2014, 62(2): 161-168.
10. Politi L, Crisci C, Montinaro F, et al. Prosthetic replacement and tangential resection of the superior vena cava in chest tumors. J Cardiovasc Surg (Torino), 2007, 48(3): 363-368.
11. 梁恒星, 劉文亮, 王翔, 等. 惡性胸腺瘤侵犯大血管的手術治療及術后生存調查. 中國現代手術學雜志, 2013, 17(2): 142-147.
12. Kawamukai K, Anotonacci F, Di Saverio S, et al. Acute postoperative cardiac herniation. Interact Cardiovasc Thorac Surg, 2011, 12(1): 73-74.
13. 周清華. 局部晚期肺癌擴大性手術的應用指征及進展. 中國癌癥雜志, 2003, 13(5): 411-415.
14. Ried M, Neu R, Schalke B, et al. Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support. J Cardiothorac Surg, 2015l, 10: 137.
15. Arif R, Eichhorn F, Kallenbach K, et al. Resection of thoracic malignancies infiltrating cardiac structures with use of cardiopulmonary bypass. J Cardiothorac Surg, 2015, 10: 87.
16. Garcia A, Flores RM. Surgical management of tumors invading the superior vena cava. Ann Thorac Surg, 2008, 85(6): 2144-2146.
17. Kim D, Kim SW, Hong JM. Rapid growing huge teratoma: complete surgical resection. J Thorac Dis, 2014, 6(10): E217-E219.
18. Lee DS, Flores RM. Superior vena caval resection in lung cancer. Thorac Surg Clin, 2014, 24(4): 441-447.
19. Okereke IC, Kesler KA, Rieger KM, et al. Results of superior vena cava reconstruction with externally stented-polytetrafluoroethylene vascular prostheses. Ann Thorac Surg, 2010, 90(2): 383-387.
20. Lee GD, Kim HR, Choi SH, et al. Prosthetic graft interposition of the brachiocephalic veins or superior vena cava combined with resection of malignant tumours: graft patency and risk factors for graft occlusion. J Thorac Dis, 2016, 8(1): 61-67.

Chinese Journal of Reparative and Reconstructive Surgery

Application of vascular repair and reconstruction in surgical treatment of superior vena cava syndrome caused by thoracic tumor

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