PMID- 17505442
OWN - NLM
STAT- MEDLINE
DCOM- 20070830
LR  - 20161026
IS  - 0021-9509 (Print)
IS  - 0021-9509 (Linking)
VI  - 48
IP  - 3
DP  - 2007 Jun
TI  - Prosthetic replacement and tangential resection of the superior vena cava in 
      chest tumors.
PG  - 363-8
AB  - AIM: Infiltration of the superior vena cava (SVC) due to advanced non small cell 
      lung cancer (NSCLC) or thymoma can be treated by prosthetic replacement or 
      tangential resection. These two technical procedures and their results are 
      described. METHODS: From 1988 to 2002, we performed 37 SVC resections: 21 
      replacements with polytetrafluoroethylene (PTFE) prostheses and 16 tangential 
      exereses. Sixteen patients affected by locally advanced NSCLC (12 T4; 4 
      extracapsular N2) and 5 subjects with thymoma (Stage III Masaoka) underwent 
      prosthetic replacement of the SVC. After neoadjuvant polychemotherapy, tangential 
      resection was performed on 12 patients with extracapsular N2 NSCLC, and in 1 
      patient with T4 and in 3 patients with T3a disease. We performed prosthetic 
      replacement in 18 cases using a straight prosthesis (?18-20 mm). A bridge (10-14 
      cm) between the innominate vein and the right atrium was created in 3 patients. 
      The main indication for a prosthetic replacement was infiltration of more than 
      30% of the circumference of the SVC. There were 4 thromboembolic complications 
      (19%), with one intraoperative death (4.8%). Tangential resection of the SVC for 
      infiltration <20% was performed both manually and with staplers (double clamping) 
      without any major complications. RESULTS: Mean survival was 23 months in those 
      patients who had undergone PTFE replacement for T4 lung cancer and for thymoma. 
      Mean survival was 15 months in those who had undergone tangential resections for 
      NSCLC with extracapsular N2. We performed restaging of the tumor using chest 
      angio-CT scan in 11 patients, one year after the operation. We found 80% patency 
      in 7 SVC prostheses and 50% patency in 4 others: the two bridges between the left 
      innominate vein and the right atrium appeared to be partially closed but were 
      compensated by important collateral circles. CONCLUSION: SVC replacement, 
      associated with pulmonary resection or removal of mediastinal masses, can be 
      performed in selected cases. It should not be considered as palliative treatment 
      because of the important perioperative risks. SVC tangential resection involves 
      fewer surgical problems. However, since this procedure is used mostly for N2 
      NSCLC subjects, patients have a low mean survival in spite of adjuvant therapy.
FAU - Politi, L
AU  - Politi L
AD  - Thoracic Surgery Unit, Department of Medical-Surgical Critical Area, Azienda 
      Ospedaliero-Universitaria Careggi, Florence, Italy.
FAU - Crisci, C
AU  - Crisci C
FAU - Montinaro, F
AU  - Montinaro F
FAU - Andreani, M
AU  - Andreani M
FAU - Podzemny, V
AU  - Podzemny V
FAU - Borzellino, G
AU  - Borzellino G
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - Italy
TA  - J Cardiovasc Surg (Torino)
JT  - The Journal of cardiovascular surgery
JID - 0066127
RN  - 9002-84-0 (Polytetrafluoroethylene)
SB  - IM
MH  - Blood Vessel Prosthesis
MH  - *Blood Vessel Prosthesis Implantation/adverse effects/instrumentation
MH  - Carcinoma, Non-Small-Cell Lung/mortality/pathology/physiopathology/*surgery
MH  - Collateral Circulation
MH  - Follow-Up Studies
MH  - Humans
MH  - Lung Neoplasms/mortality/pathology/physiopathology/*surgery
MH  - Neoplasm Invasiveness
MH  - Neoplasm Staging
MH  - Polytetrafluoroethylene
MH  - Prosthesis Design
MH  - Thromboembolism/etiology
MH  - Thymoma/mortality/pathology/physiopathology/*surgery
MH  - Thymus Neoplasms/mortality/pathology/physiopathology/*surgery
MH  - Time Factors
MH  - Tomography, X-Ray Computed
MH  - Treatment Outcome
MH  - Vascular Patency
MH  - Vascular Surgical Procedures/adverse effects/instrumentation/*methods
MH  - Vena Cava, Superior/pathology/physiopathology/*surgery
EDAT- 2007/05/17 09:00
MHDA- 2007/08/31 09:00
CRDT- 2007/05/17 09:00
PHST- 2007/05/17 09:00 [pubmed]
PHST- 2007/08/31 09:00 [medline]
PHST- 2007/05/17 09:00 [entrez]
PST - ppublish
SO  - J Cardiovasc Surg (Torino). 2007 Jun;48(3):363-8.