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.	杨永波, 尤嘉琮, 周清华. 胸部肿瘤引起的上腔静脉综合征的外科治疗. 中国肺癌杂志, 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.	谢亮, 陈刚, 邓澄, 等. 累及心脏大血管的复杂纵隔肿瘤的临床外科处理. 中国胸心血管外科临床杂志, 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, 陈景寒, 孟龙, 等. 肺癌累及上腔静脉的外科治疗. 中华外科杂志, 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, 任华, 等. 上腔静脉和无名静脉的切除及重建治疗纵隔肿瘤.中国胸心血管外科杂志, 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, 刘文亮, 王翔, 等. 恶性胸腺瘤侵犯大血管的手术治疗及术后生存调查. 中国现代手术学杂志, 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.	周清华. 局部晚期肺癌扩大性手术的应用指征及进展. 中国癌症杂志, 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. 杨永波, 尤嘉琮, 周清华. 胸部肿瘤引起的上腔静脉综合征的外科治疗. 中国肺癌杂志, 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. 谢亮, 陈刚, 邓澄, 等. 累及心脏大血管的复杂纵隔肿瘤的临床外科处理. 中国胸心血管外科临床杂志, 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, 陈景寒, 孟龙, 等. 肺癌累及上腔静脉的外科治疗. 中华外科杂志, 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, 任华, 等. 上腔静脉和无名静脉的切除及重建治疗纵隔肿瘤.中国胸心血管外科杂志, 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, 刘文亮, 王翔, 等. 恶性胸腺瘤侵犯大血管的手术治疗及术后生存调查. 中国现代手术学杂志, 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. 周清华. 局部晚期肺癌扩大性手术的应用指征及进展. 中国癌症杂志, 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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