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The Journal of Thoracic and Cardiovascular Surgery, Vol 102, 259-265, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
PG Dartevelle, AR Chapelier, U Pastorino, P Corbi, B Lenot, J Cerrina, EA Bavoux, JM Verley and JY Neveux
The contraindication to curative excision of mediastinal and pulmonary
cancers because of invasion of the superior vena cava is now challenged by
the existence of vascular prostheses that are suitable for venous
replacement. Between 1979 and 1990 22 patients underwent resection of lung
cancer (n = 6) or malignant mediastinal tumors (n = 16) involving the
superior vena cava. Resection was done with concomitant venous
reconstruction, and polytetrafluorethylene grafts were used. All
bronchogenic carcinomas necessitated right pneumonectomy, whereas the
excision of mediastinal tumors had to include pulmonary resections in nine
patients (five lobectomies and four sublobar resections) and the right
phrenic nerve in 12 patients. Venous reconstruction was performed by
interposition of a large polytetrafluoroethylene graft between the proximal
and cardiac ends of the superior vena cava (n = 8), or between one (n = 10)
or both brachiocephalic veins (n = 4) and the right atrium. One patient
died postoperatively (4.5%), and another had mediastinitis that was
successfully treated by omentopexy. Chemotherapy was administered
preoperatively to five patients and postoperatively to seven patients;
radiotherapy was administered to two and 10 patients, respectively. The
overall actuarial survival rate is 48% at 5 years, with 11 patients
presently alive. The survival rate of patients with mediastinal tumors is
60% at 5 years. Among the patients with lung cancer, two with N1 disease
are alive at 16 and 51 months, and one died at 38 months; the two patients
with N2 disease died at 6 and 8 months. Only one graft occlusion occurred
in the postoperative period; another occurred 14 months after operation and
was precipitated by insertion of a central venous catheter. The patency of
all remaining grafts was demonstrated after an average time of 23 (1 to 98)
months. On the basis of these results, polytetrafluoroethylene graft
replacement of the superior vena cava should be part of the planning and
execution of radical excision with curative intent of mediastinal and right
pulmonary malignant tumors that are not present with other
contraindications, such as pleural or distant metastasis and severe
systemic disease.
ARTICLES
Long-term follow-up after prosthetic replacement of the superior vena cava combined with resection of mediastinal-pulmonary malignant tumors
Department of Thoracic and Vascular Surgery, Hopital Marie Lannelongue, Plessis Robinson, France.
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