Extended operation for lung cancer invading the superior vena cava

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Abstract
Between 1981 and 1991, 845 patients were operated on for right lungcancer. Among them, 50 (6%) had a tumor invading the superior vena cava(SVC). Fifteen patients (14 men and 1 woman, mean age: 58 years) underwentradical resection with concomitant vascular reconstruction. Two patientspresented with a superior vena caval syndrome. The SVC was invaded bydirect extension from the tumor (n = 11) or by paratracheal nodalinvolvement (n = 4). The patients required pneumonectomy (n = 13) or upperlobectomy (n = 2), with lateral (n = 11) or circumferential resection (n =4) of the SVC. The venous pathway was repaired by direct suture (n = 9),prosthetic patch (n = 2) or polytetrafluoroethylene (PTFE) graft (n = 4).Tumor resection was considered macroscopically complete in 12 patients(80%). One patient died postoperatively (7%) and non-fatal complicationsoccurred in 3 (20%). Early patency of the four grafts was assessed byphlebography. In the late course, pulmonary embolism occurred in twopatients and extended superior vena caval thrombosis in one; the overallclinical patency rate was 75.7% at 1 and 5 years. Two patients (13.3%)experienced mediastinal recurrence; the overall survival rates at 1 year, 2years and 5 years were, respectively, 46.7%, 32% and 24% (median: 8.5months). We conclude that extended resection for lung cancer invading theSVC, when feasible, is justified given the effective control of the primarytumor thereby provided, with an acceptable operative risk.

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