1
|
Duranti L, Tavecchio L. Major vascular reconstructions in thoracic oncological surgery. Updates Surg 2024; 76:1887-1898. [PMID: 38421567 DOI: 10.1007/s13304-024-01763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/16/2024] [Indexed: 03/02/2024]
Abstract
The replacement of the superior vena cava and thoracic outlet vessels for thoracic malignancies often becomes necessary for radical oncological surgery. The pulmonary artery can be directly infiltrated by the tumor or affected by metastatic hilar lymph nodes. In some cases, it must be resected and reconstructed to achieve oncological radicality and/or avoid pneumonectomy. This study reflects a single-surgeon, retrospective experience spanning 6 years (2017-2023). We reviewed data from patients undergoing early anticoagulant therapy after superior vena cava or thoracic outlet vessels bypass and from patients undergoing early antiaggregation therapy following pulmonary artery reconstruction or resection. This series comprises 41 patients treated by a single surgeon. Fourteen patients underwent superior vena cava and thoracic outlet vessel procedures. Among these, eight patients received superior vena cava replacement (six for thymic malignancies and two for lung cancer), and six patients underwent jugular and subclavian artery/vein resection or replacement (all six had sarcomas). There was one death due to respiratory failure, not associated with bleeding or bypass closure. Additionally, there was one graft closure in a patient with severe coagulopathy and three instances of hemothorax (two patients had undiagnosed complex coagulopathies not evident in pre-operative routine blood tests). Following bleeding incidents, anticoagulation was initiated the next day in one case and based on hematological indications in the two coagulopathic patients. In the pulmonary artery series, 27 patients were involved: 20 underwent direct suture after tangential resection, and 7 received pericardial patch reconstruction. Only one case experienced bleeding necessitating redo-surgery. All these patients received early and chronic antiaggregation therapy after pulmonary artery reconstruction. We conclude that major thoracic oncological vascular surgery is safe and feasible with appropriate technical skills. However, achieving optimal results requires integration with correct early anticoagulant therapy or antiaggregation to maintain the patency of bypasses/grafts and prevent life-threatening risks associated with closure of the "new vessels."
Collapse
Affiliation(s)
- Leonardo Duranti
- Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Via Venezian 1, 20133, Milan, Italy.
| | - Luca Tavecchio
- Thoracic Surgery Unit, IRCCS Istituto Nazionale dei Tumori Foundation, Via Venezian 1, 20133, Milan, Italy
| |
Collapse
|
2
|
Hao X, Gu Z, Liu H, Zhang X, Xu N, Mao T, Fang W. Internal jugular vein pressure monitoring guided venous reconstruction could improve perioperative safety after superior vena cava resection for mediastinal tumors: a cohort study. Int J Surg 2024; 110:2730-2737. [PMID: 38320105 DOI: 10.1097/js9.0000000000001150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/26/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION After superior vena cava (SVC) resection, the decision on unilateral or bilateral reconstruction was mostly based on the expertise of surgeons without objective measurements. This study explored the use of internal jugular vein pressure (IJVP) monitoring to guide the SVC reconstruction strategy. METHODS In a retrospective cohort, perioperative outcomes of unilateral and bilateral reconstruction based on surgeons' experience were compared. Then, IJVP threshold was measured when temporarily clamping the left innominate vein in a testing cohort. Venous reconstruction according to IJVP monitoring was performed in a prospective validation cohort afterward. Perioperative outcomes were compared between the prospective and the retrospective cohorts. For some interested variables, intuitive explanations would be given using Bayesian methods. Potential risk factors for postoperative complications were investigated by multivariable analysis. RESULTS From March 2009 to September 2022, 57 patients underwent SVC reconstruction based on surgeons' experience. Bayesian analysis indicated a posterior probability of 80.49% that unilateral reconstruction had less blood loss than bilateral reconstruction (median 550 ml vs. 1200 ml). Cerebral edema occurred in two patients after unilateral reconstruction. In the testing cohort, median IJVP was 22.7 (18-27) cmH 2 O after temporary left innominate vein clamping in 10 patients. In the prospective cohort, unilateral reconstruction only was performed if the contralateral IJVP was <30 cmH 2 O in 16 patients. Bilateral reconstruction was performed if IJVP was ≥30 cmH 2 O after unilateral bypass in nine patients. No cerebral edema occurred in the prospective cohort. Less postoperative complications occurred in the prospective cohort than the retrospective cohort (12.0 vs. 38.6%, P =0.016). Upon multivariable analysis, IJVP-monitoring guided SVC reconstruction was associated with significantly less postoperative complications ( P =0.033). CONCLUSIONS Intraoperative IJVP-monitoring is a useful strategy for selection of unilateral or bilateral SVC reconstruction and improving perioperative safety in patients with mediastinal tumors.
Collapse
Affiliation(s)
- Xiuxiu Hao
- Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|
3
|
Jiang JH, Zhang Y, Gao J, Ding JY. Artificial reconstruction for a thymoma invading superior vena cava. JTCVS Tech 2022; 15:195-198. [PMID: 36276706 PMCID: PMC9579700 DOI: 10.1016/j.xjtc.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/25/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
| | | | | | - Jian-Yong Ding
- Address for reprints: Jian-Yong Ding, MD, Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.
| |
Collapse
|
4
|
Postoperative anticoagulation in vascular reconstructions associated with malignancies. Ann Vasc Surg 2022; 86:219-228. [DOI: 10.1016/j.avsg.2022.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 03/20/2022] [Accepted: 04/05/2022] [Indexed: 11/22/2022]
|
5
|
Tosi D, Damarco F, Franzi S, Mohamed S, Palleschi A, Mendogni P. Outcomes of extended surgical resections for locally advanced thymic malignancies: a narrative review. Gland Surg 2022; 11:611-621. [PMID: 35402207 PMCID: PMC8984987 DOI: 10.21037/gs-21-642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 12/14/2021] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND OBJECTIVE Thymic malignancies represent the most common anterior mediastinal neoplasms, as well as rare and challenging tumors. Surgery is the cornerstone in the treatment of thymic malignancies, although a multidisciplinary approach is mandatory, for both, locally advanced or metastatic disease. In our narrative review, we explored the recent literature to investigate clinical and radiological assessment, multimodality approach and outcomes of locally advanced thymic tumors. More than one-third of patients affected by an anterior mediastinal mass are asymptomatic at diagnosis. In case of locally advanced thymoma, symptoms are related to compression or invasion of adjacent structures, such as the superior vena cava (SVC), innominate veins and pericardium. Paraneoplastic syndromes, such as myasthenia gravis (MG), are related to release of antibodies, hormones and cytokines. METHODS Diagnostic methods must be chosen accurately to avoid unnecessary surgical resections, to define the best strategy of care, and to plan the surgical strategy. Therefore, each case must be evaluated in a multidisciplinary context, where surgery plays an essential role. KEY CONTENT AND FINDINGS In this narrative review, we describe indications and surgical techniques for the treatment of locally advanced thymoma; focusing on oncological outcomes after different approaches. CONCLUSIONS In conclusion, aggressive surgery is always indicated, when possible, and when a complete resection can be planned, yet, the multidisciplinary approach is mandatory, in case of both locally or metastatic advanced disease.
Collapse
Affiliation(s)
- Davide Tosi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Damarco
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Franzi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Alessandro Palleschi
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- University of Milan, Milan, Italy
| | - Paolo Mendogni
- Thoracic Surgery and Lung Transplantation Unit, IRCCS Foundation Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| |
Collapse
|
6
|
Filaire L, Mercier O, Seguin-Givelet A, Tiffet O, Falcoz PE, Mordant P, Brichon PY, Lacoste P, Aubert A, Thomas P, Le Pimpec-Barthes F, Molnar I, Vidal M, Filaire M, Galvaing G. Superior vena cava graft infection in thoracic surgery: a retrospective study of the French EPITHOR database. Interact Cardiovasc Thorac Surg 2021; 34:378-385. [PMID: 34871387 PMCID: PMC8860414 DOI: 10.1093/icvts/ivab337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/22/2021] [Accepted: 10/31/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To report our experience on the management of superior vena cava graft infection. METHODS Between 2001 and 2018, patients with superior vena cava synthetic graft or patch reconstruction after resection of intrathoracic tumours or benign disease were selected retrospectively from the French EPITHOR database and participating thoracic centres. Our study population includes patients with superior vena cava graft infection, defined according to the MAGIC consensus. Superior vena cava synthetic grafts in an empyema or mediastinitis were considered as infected. RESULTS Of 111 eligible patients, superior vena cava graft infection occurred in 12 (11.9%) patients with a polytetrafluoroethylene graft secondary to contiguous contamination. Management consisted of either conservative treatment with chest tube drainage and antibiotics (n = 3) or a surgical graft-sparing strategy (n = 9). Recurrence of infection appears in 6 patients. Graft removal was performed in 2 patients among the 5 reoperated patients. The operative mortality rate was 25%. CONCLUSIONS Superior vena cava graft infection may develop as a surgical site infection secondary to early mediastinitis or empyema. Graft removal is not always mandatory but should be considered in late or recurrent graft infection or in infections caused by aggressive microorganisms (virulent or multidrug resistant bacteria or fungi).
Collapse
Affiliation(s)
- Laura Filaire
- Department of Thoracic and Endocrine Surgery, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart and Lung Transplantation, Hôpital Marie Lannelongue, Paris, France
| | | | - Olivier Tiffet
- Department of Thoracic Surgery, North Hospital, Saint-Étienne, France
| | | | - Pierre Mordant
- Division of Thoracic and Vascular Surgery, Hôpital Bichat, Paris, France
| | - Pierre-Yves Brichon
- Department of Thoracic and Endocrine Surgery, University Hospital of Grenoble, Grenoble, France
| | - Philippe Lacoste
- Department of Thoracic and Cardiovascular Surgery, Nantes Hospital University, Nantes, France
| | - Axel Aubert
- Department of Thoracic Surgery, Clinique Belledone, Grenoble, France
| | - Pascal Thomas
- Department of Thoracic Surgery, Disease of the Oesophagus and Lung Transplantation, North Hospital, Marseille, France
| | | | - Ioana Molnar
- Department of Clinic Research, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France
| | - Magali Vidal
- Infectious Diseases Unit, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Marc Filaire
- Department of Thoracic and Endocrine Surgery, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France
| | - Géraud Galvaing
- Department of Thoracic and Endocrine Surgery, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France
| |
Collapse
|
7
|
Cusimano RJ, Shamji FM. Superior Vena Cava Resection and Reconstruction with Resection of Primary Lung Cancer and Mediastinal Tumor. Thorac Surg Clin 2021; 31:463-468. [PMID: 34696858 DOI: 10.1016/j.thorsurg.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The superior vena cava is a short ∼7-cm valveless vessel that brings blood from the upper half of the body to the heart but has connections to the infracardiac venous structures as well. It can become obstructed, mostly by advanced lung cancer but benign conditions account for one-fourth of cases. When possible, reconstruction can be by biological material or via ring reinforced grafts. When perfomed, replacement should be with small caliber grafts to allow for rapid flow of blood, which, with the addition of anticoagulants, reduces the risk of thrombosis. Even with advanced malignancy, treatment may confer reasonable survival.
Collapse
Affiliation(s)
- Robert James Cusimano
- University of Toronto, Peter Munk Cardiac Centre, Toronto General Hospital, 4n468. 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
| | - Farid M Shamji
- University of Ottawa, General Campus, Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario K1H 8L6, Canada
| |
Collapse
|
8
|
Vascular Involvement in Thymic Epithelial Tumors: Surgical and Oncological Outcomes. Cancers (Basel) 2021; 13:cancers13133355. [PMID: 34283085 PMCID: PMC8269305 DOI: 10.3390/cancers13133355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/25/2021] [Accepted: 07/02/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The involvement of mediastinal great vessels is common in advanced stage thymic tumors, which makes their surgical resection challenging. Moreover, the impact of vascular involvement on the oncological prognosis is still unclear. The aim of this study is to investigate the surgical and oncological outcomes and the impact of vascular involvement in a population of patients operated for advanced stage thymic tumors. METHODS A retrospective analysis on four hundred and sixty-five patients undergoing resection for advanced stage (Masaoka III-IV) thymic tumors in a single high-volume center was performed. One hundred forty-four patients met the inclusion criteria and were eligible for the study. Patients were divided in two groups according to the presence or absence of vascular involvement. RESULTS the two groups did not differ for the baseline characteristics and showed comparable surgical outcomes. Vascular involvement was not associated with worse overall survival but with an increased recurrence rate (p = 0.03). Multivariable analysis demonstrated a higher risk of recurrence in patients without R0 resection (HR 0.11, 0.02-0.54, p = 0.006) and with thymic carcinoma (HR 2.27, 1.22-4.24, p = 0.01). CONCLUSIONS resection of thymic tumors with vascular involvement can be performed with optimal surgical results in a high volume center. From the oncological point of view, the involvement of the great vessels seems to be associated with a higher recurrence rate without affecting long-term survival.
Collapse
|
9
|
Chenesseau J, Mitilian D, Sharma G, Mussot S, Boulate D, Haulon S, Fabre D, Mercier O, Fadel E. Superior vena cava prosthetic replacement for non-small cell lung cancer: is it worthwhile? Eur J Cardiothorac Surg 2021; 60:1195-1200. [PMID: 34198335 DOI: 10.1093/ejcts/ezab248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Direct involvement of the superior vena cava (SVC) by non-small cell lung cancer (NSCLC) requires en-bloc tumour resection with complete vascular clamping and prosthetic replacement. We report the outcomes of this highly demanding procedure in the largest patient cohort to date. METHODS We searched our institution's database for patients who underwent complete en-bloc resection of NSCLC invading the SVC followed by prosthetic SVC replacement, between 1980 and 2018. Patients with cN2, cN3 or distant metastases were not eligible. RESULTS We identified 48 patients (38 males, 10 females; mean age of 57 years; tumour size, 1.9-17 cm). Neoadjuvant therapy was administered to 17 and adjuvant therapy to 31 patients. R0 resection was achieved in 41 (85%) patients; lymph node involvement was pN0 in 8, pN1 in 23, pN2 in 14 and pN3 in 3 patients. Five patients died within 30 days of surgery. Right pneumonectomy was significantly associated with postoperative death (P = 0.02). Postoperative complications developed in 13 other patients. No neurologic events related to SVC clamping occurred. Graft thrombosis developed in 2 patients. Median survival was 24 months; 3-, 5- and 10-year survival rates were 45%, 40% and 35%, respectively; and corresponding disease-free survival rates were 37%, 37% and 30%, respectively. By univariable analysis, only margin-free (R0) resection was associated with better survival (P = 0.02). CONCLUSIONS In highly selected patients with NSCLC involving the SVC, mortality is acceptable after complete en-bloc resection and prosthetic replacement done in an expert centre. SVC involvement should not preclude consideration of curative resection in selected patients.
Collapse
Affiliation(s)
- Josephine Chenesseau
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Delphine Mitilian
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Gaurav Sharma
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Sacha Mussot
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - David Boulate
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Stephan Haulon
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Dominique Fabre
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery, Marie Lannelongue Hospital and Paris Saclay University, Le Plessis-Robinson, France
| |
Collapse
|
10
|
Chen W, Lei J, Wang Y, Tang X, Liu B, Li Z, Zhou Q. Case Report: Superior Vena Cava Resection and Reconstruction for Invasive Thyroid Cancer: Report of Three Cases and Literature Review. Front Surg 2021; 8:644605. [PMID: 34141718 PMCID: PMC8204692 DOI: 10.3389/fsurg.2021.644605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 05/07/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Thyroid cancer with massive invasion into the cervical and mediastinal great veins is extremely rare, and the surgical treatment is controversial, thus posing a great challenge for head and neck surgeons. Here, we report our successful experiences in reconstructing the superior vena cava (SVC) system to treat thyroid cancer with an extensive tumor thrombus growing intraluminally into the SVC. Case Presentation: From September 2019 to September 2020, three patients with superior vena cava syndrome(SVCS) caused by tumor thrombus invasion from thyroid cancer were continuously included in this series. After preoperative evaluation, radical resection and reconstruction of the SVC system with expanded polytetrafluoroethylene (EPTFE) grafts were performed. In addition, bypass support from the right internal jugular vein to the right femoral vein was routinely prepared intraoperatively to prevent a rise in central venous pressure (CVP). Postoperatively, SVC-related syndrome improved immediately after the operation. Imaging examination showed good function of the reconstructed venous system. The patients recovered well with no surgical complications and remain under continuous follow-up. Conclusions: Tumor growth into the SVC does not seem to be an absolute contraindication for surgery for thyroid carcinoma. Comprehensive treatment, including reconstruction of the SVC, is effective for relieving symptoms and preventing disease progression and is thus worth advocating. In addition, bypass support from the internal jugular vein to the femoral vein is easy to implement and can improve the safety of the operation.
Collapse
Affiliation(s)
- Wenjie Chen
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jianyong Lei
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yichao Wang
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaojun Tang
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, China
| | - Zhihui Li
- Thyroid and Parathyroid Surgery Center, West China Hospital of Sichuan University, Chengdu, China
| | - Qinghua Zhou
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| |
Collapse
|
11
|
Haywood N, Kron IL. Commentary: Superior vena cava reconstruction techniques. JTCVS Tech 2020; 4:187-188. [PMID: 34318007 PMCID: PMC8308504 DOI: 10.1016/j.xjtc.2020.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nathan Haywood
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| | - Irving L Kron
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, Va
| |
Collapse
|
12
|
Abstract
Resection is the mainstay of treatment for thymic epithelial tumors (TETs), with complete removal of the tumor and involved organs being the ultimate aim. The choice of surgical approach plays a major role in defining treatment success, and the optimal choice of method should thus provide an adequate surgical view to achieve complete tumor resection. While median sternotomy is considered the gold standard for access to the mediastinum, several minimally invasive approaches to thymectomy have been described, including video-assisted robotic-assisted thymectomy, although the oncological outcomes of that procedure remain unclear. A multimodal approach incorporating chemotherapy or chemoradiotherapy followed by extended surgery may improve resectability and outcomes for patients with advanced TETs. Surgical debulking is also reportedly acceptable for invasive thymoma because of its potential for achieving favorable outcomes. Re-resection is an acceptable option for patients with recurrent thymoma after initial resection, and repeat resection for recurrent pleural dissemination seems effective. Here, the literature on current clinical practices in the surgical management and treatment of TETs is reviewed.
Collapse
|
13
|
Handa K, Hata H, Toda K, Miyagawa S, Yoshikawa Y, Yoshioka D, Sawa Y. Orthotopic heart transplantation with reconstruction of persistent left superior vena cava. Surg Case Rep 2020; 6:71. [PMID: 32297140 PMCID: PMC7158957 DOI: 10.1186/s40792-020-00834-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent left superior vena cava is a not uncommon congenital vascular abnormality. We report a case of heart transplantation with reconstruction of persistent left superior vena cava using a prosthetic vascular graft. CASE PRESENTATION A 20-year-old man with idiopathic dilated cardiomyopathy and persistent left superior vena cava underwent orthotopic heart transplantation 2 years and 3 months after left ventricular assist device implantation. Because the persistent left superior vena cava had a larger diameter than the right superior vena cava, the transected persistent left superior vena cava was reconstructed with a prosthetic vascular graft anastomosed to the free wall of the right atrium. Postoperative enhanced computed tomography revealed good patency of the graft. The patient's postoperative course has been uneventful during 2 years of follow-up, despite the risk of complications. CONCLUSIONS Reconstruction of a persistent left superior vena cava with a prosthetic vascular graft may be one option at the time of heart transplantation.
Collapse
Affiliation(s)
- Kazuma Handa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroki Hata
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yasushi Yoshikawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| |
Collapse
|
14
|
Zhang Z, Huang M, Pan X. Prosthetic Reconstruction of Superior Vena Cava System for Thymic Tumor: A Retrospective Analysis of 22 Cases. Thorac Cardiovasc Surg 2020; 69:165-172. [PMID: 32005044 DOI: 10.1055/s-0039-3401044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to report our experience in superior vena cava (SVC) resection and reconstruction for 22 thymic tumor patients and to make comparisons with previous related reports. METHODS A retrospective study on 22 patients (15 thymomas, 7 thymic cancers) who underwent tumor resection with concomitant SVC reconstruction. All the patients underwent vascular conduit reconstruction by the cross-clamping technique. The corresponding data were reviewed, including clinical presentation, operation management (surgery procedure, selection of suitable graft, strategies against SVC syndrome, etc.), postoperative cares (antithrombotic agent application, treatments on brain edema, etc.), and follow-up information. RESULT Two patients were myasthenic, well controlled by oral pyridostigmine. All resections were radical (R0). Ten patients received induction treatment. All the 15 thymoma patients were Masaoka stage III (type B1-B3). As for thymic cancer, six patients were Masaoka stage III and one was stage IVa. Wedge pulmonary resection was performed in three patients (two right upper lobe, one both upper lobe). Procedures included were single graft replacement in 12 patients, bilateral grafts in 9, and Y-shaped graft in 1 patient. Anticoagulation and dehydration agents were routinely applied after operation. No perioperative mortalities were observed. Major complication rate was 9.1%. The median survival time was 44.2 months (range, 4-92 months). Three- and 5-year overall survival rates were 80.8 and 44.0%, respectively. As for conduit patency, two grafts (9.1%) demonstrated evidence of occlusion during long-term follow-up, but no additional interventions were required due to no complications related. CONCLUSION Our study, confirming data from existing literature, showed that the prosthetic reconstruction of the SVC system is a feasible additional procedure during resection of thymic tumor infiltrating the venous mediastinal axis, minimally increasing postoperative complications in experienced hands.
Collapse
Affiliation(s)
- Zhenglong Zhang
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, China
| | - Minhui Huang
- International Medical Examination Center, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, Fujian, China
| | - Xiaojie Pan
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fujian Provincial Clinical Medical College of Fujian Medical University, Fuzhou, China
| |
Collapse
|
15
|
Zhang S, Tan D, Wu W, He B, Jing T, Tang M, Wu T, Liu H, Zhang M, Zhou N, Tang L, Chen Q, Tang J, Xia M, Huang A, Liao Y, Qiu Y, Wang H. Extracorporeal membrane oxygenation (ECMO) assisted mediastinal tumor resection and superior vena cava replacement are safe and feasible. Thorac Cancer 2019; 10:1846-1851. [PMID: 31297984 PMCID: PMC6718025 DOI: 10.1111/1759-7714.13140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 11/29/2022] Open
Abstract
Background How to maximally improve the drainage of intracranial and upper body venous and to reduce neurological complications during thoracic tumor‐causedsuperior vena cava replacement are still clinical problems to be solved. Methods We have innovatively used the bilateral jugular vein‐left femoral vein ECMO shunting to perform mediastinal tumor resection and superior vena cava replacement in a 50‐year‐old woman. Results During the operation, this technique maintained the patient's hemodynamic stability, improved the cerebral oxygen saturation and reduced the cerebral ischemia, hypoxia as well as the neurological complications. Conclusion It is indicated for patients with superior vena cava replacement who are unable to perform venous bypass (such as innominate vein to right atrial bypass) or venous shunting (such as differential pressure drainage from internal jugular vein to femoral vein).
Collapse
Affiliation(s)
- Shixin Zhang
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Deli Tan
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wei Wu
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Bo He
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Tao Jing
- Department of Vasculocardiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Meng Tang
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Tao Wu
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Hongxiang Liu
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ming Zhang
- Department of Anesthesiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ni Zhou
- Department of Anesthesiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Lingfeng Tang
- Department of Cardiac Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qiao Chen
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jinghua Tang
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Mei Xia
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Aihong Huang
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yi Liao
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yang Qiu
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Haidong Wang
- Department of Thoracic Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| |
Collapse
|
16
|
Maurizi G, Poggi C, D’Andrilli A, Vanni C, Ciccone AM, Ibrahim M, Andreetti C, Tierno SM, Venuta F, Rendina EA. Superior Vena Cava Replacement for Thymic Malignancies. Ann Thorac Surg 2019; 107:386-392. [DOI: 10.1016/j.athoracsur.2018.08.060] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 08/25/2018] [Accepted: 08/28/2018] [Indexed: 10/28/2022]
|
17
|
Hoshino H, Matsunaga T, Takamochi K, Oh S, Suzuki K. Is postoperative anticoagulation necessary after left innominate vein division in general thoracic surgery? Gen Thorac Cardiovasc Surg 2018; 67:254-258. [PMID: 30374812 DOI: 10.1007/s11748-018-1019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/01/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We encounter patients with mediastinal tumors invading the left innominate vein (LIV), and there is no evidence confirming whether the LIV should simply be ligated or reconstructed. The need for postoperative anticoagulant therapy after ligation of LIV is also controversial. METHODS 3209 patients with thoracic malignant tumors underwent surgical resection between 1994 and 2014 in our institute. Nineteen (0.6%) patients had mediastinal malignant tumors invading the LIV and underwent LIV resection. Of these patients, only 3 underwent reconstruction of LIV. We did not start anticoagulant therapy routinely after resection of LIV. The patients were divided into 2 groups: group A showed at least 50% patency of LIV by preoperative contrast-enhanced computed tomography (CECT) and group B showed less than 50%. We investigated the safety of resecting LIV and the need for postoperative anticoagulant therapy. RESULTS The 30-day and 90-day mortalities were zero in both groups. Thrombosis of the LIV stump and increased edema in the left neck and upper limb were observed in 2 (10.5%) patients only in group A. After initiating the anticoagulant therapy, the embolisms disappeared and weaning the patients off warfarin could be done in less than 1 year. CONCLUSIONS In this study, there was no case of mortality or severe morbidity among the patients with LIV resection. Moreover, there was no need to initiate routine anticoagulant therapy after the LIV division as the frequency of embolism in the LIV stump was low and was expected to disappear prior to starting anticoagulant therapy.
Collapse
Affiliation(s)
- Hironobu Hoshino
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3 Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Takeshi Matsunaga
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3 Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kazuya Takamochi
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3 Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Shiaki Oh
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3 Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3 Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
| |
Collapse
|
18
|
Ilonen I, Jones DR. Initial extended resection or neoadjuvant therapy for T4 non-small cell lung cancer-What is the evidence? ACTA ACUST UNITED AC 2018; 2. [PMID: 30498811 DOI: 10.21037/shc.2018.09.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Locally advanced non-small cell lung cancer (NSCLC) tumors that invade surrounding structures within the chest (T4) are a heterogeneous group, and, as such, there are no straightforward guidelines for their management. Advances in imaging, invasive mediastinal staging, and neoadjuvant therapies have expanded the role of surgery with curative intent for this patient group and have also diminished the rate of explorative thoracotomies. Unlike for T4 superior sulcus tumors, the use of neoadjuvant therapy for central T4 tumors is not clearly defined. The most important determinants of a successful outcome after surgery are achieving an R0 resection and avoiding incidental pathologic N2 disease. Use of neoadjuvant therapy in this setting may yield better outcomes after surgery, as both of these variables can be altered if the tumor responds to neoadjuvant therapy. Moreover, response to induction therapy has been shown to have prognostic value.
Collapse
Affiliation(s)
- Ilkka Ilonen
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
19
|
Zhang S, Liu X, Huang W, Li J. [A Programmed Procedure of Prosthetic Reconstruction of the Superior Vena Cava
for Thoracic Tumors via Median Thoracotomy]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 20:751-754. [PMID: 29167004 PMCID: PMC5973279 DOI: 10.3779/j.issn.1009-3419.2017.11.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
背景与目的 上腔静脉系统受累是局部晚期胸部肿瘤较常见的一种情况,手术可能获益,但风险极高。本研究针对正中开胸入路,提出一种程序化的手术方案,旨在优化流程,使得这一类以往认为风险极高的手术能够更加安全地实施。 方法 35例胸部疾患累及上腔静脉系统,经正中开胸进行人工血管置换的患者资料,分期检查明确为局部晚期。包括肺部肿瘤16例,纵隔肿瘤19例。手术方法采用从左至右的单向推进,先游离左无名静脉起始部,阻断后切断,掀起瘤体,打开心包,用人工血管桥接左无名静脉和右心耳。游离上腔静脉近心端未受侵部分后,向尾侧牵拉肿瘤,剪开右侧纵隔胸膜,结扎切断右侧乳内血管,可以充分显露右无名静脉。向左上方牵拉瘤体,于肺门上方结扎切断奇静脉,此时可以阻断右无名静脉和上腔静脉,切除中间受侵的血管,以人工血管行右无名静脉-上腔静脉桥接,完成受侵的上腔静脉系统全部替换。 结果 全组病例均顺利完成手术。术后并发症包括:心律失常6例,低氧血症5例,肌无力危象1例,心脏疝1例,真菌感染2例。2例患者死亡,死亡率5.12%,分别死于心梗和肺部感染。其余33例顺利出院。平均术后住院日15 d。在10例术前出现上腔静脉综合征的患者中,除2例术中即出现人工血管内血栓形成的患者,其余8例症状均明显改善。 结论 上腔静脉人工血管置换手术经程序化的处理,规范治疗的细节,在手术操作过程中可降低手术风险,本组病例手术能够安全实施的实践也支持这一点。
Collapse
Affiliation(s)
- Shijie Zhang
- Department of Thoracic Surgery, Peking University First Hospital, Beijing 100034, China
| | - Xiangzheng Liu
- Department of Thoracic Surgery, Peking University First Hospital, Beijing 100034, China
| | - Weiming Huang
- Department of Thoracic Surgery, Peking University First Hospital, Beijing 100034, China
| | - Jian Li
- Department of Thoracic Surgery, Peking University First Hospital, Beijing 100034, China
| |
Collapse
|
20
|
Kaba E, Özkan B, Özyurtkan MO, Ayalp K, Toker A. Superior vena cava resection and reconstruction in mediastinal tumors and benign diseases. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2018; 26:99-107. [PMID: 32082718 PMCID: PMC7018129 DOI: 10.5606/tgkdc.dergisi.2018.14292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 05/01/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND This study aims to evaluate our results of resection and reconstruction of the superior vena cava invaded by mediastinal tumors and benign diseases. METHODS Seventeen patients (8 males, 9 females; mean age 46±17 years; range 9 to 74 years) undergoing superior vena cava resection and reconstruction due to mediastinal pathologies between September 2006 and September 2016 were retrospectively reviewed. Patients who had angioplasty with primary suturing or partial resection with stapler were excluded. Mortality and morbidity rates were analyzed based on the demographic, and intra- and postoperative measures. RESULTS Majority of patients (94%) had mediastinal tumors. Twelve patients (71%) had thymic epithelial tumors. Tubular graft interposition was performed using ringed polytetrafluoroethylene prosthesis in nine patients (53%), while patch plasty using autologous pericardium, polytetrafluoroethylene or Dacron grafts was performed in eight patients (47%). Eleven patients (65%) necessitated concomitant resections of neighboring structures. Mean length of hospital stay was 11±6 days. There was no intraoperative death. Mortality occurred in three patients (18%). Five patients (29%) developed complications. Mortality occurred commonly in elderly patients (p<0.0001). Postoperative complications were more common in patients with concomitant resections (p=0.05). Neither acute nor chronic thrombosis developed in any patients. Median survival in patients with malignant diseases was 57 months, with a oneyear and three-year probability of survival of 83% and 74%, respectively. CONCLUSION Replacement of superior vena cava should be included in the therapeutic algorithm of selected patients with mediastinal tumors and benign diseases. Mortality rates may be higher in older patients, while the need for concomitant resections may increase morbidity rates.
Collapse
Affiliation(s)
- Erkan Kaba
- Department of Thoracic Surgery, İstanbul Bilim University, Faculty of Medicine, İstanbul, Turkey
| | - Berker Özkan
- Department of Thoracic Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Oğuzhan Özyurtkan
- Department of Thoracic Surgery, İstanbul Bilim University, Faculty of Medicine, İstanbul, Turkey
| | - Kemal Ayalp
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, İstanbul, Turkey
| | - Alper Toker
- Department of Thoracic Surgery, İstanbul University İstanbul Faculty of Medicine, İstanbul, Turkey
- Department of Thoracic Surgery, Group Florence Nightingale Hospitals, İstanbul, Turkey
| |
Collapse
|
21
|
Shiraishi S, Sugimoto A, Moon J, Takahashi M, Tsuchida M. A Case Report of Reconstruction of the Left Superior Vena Cava Using the Right Superior Vena Cava Autograft at Bilateral Bidirectional Superior Cavopulmonary Anastomosis. World J Pediatr Congenit Heart Surg 2017; 11:NP63-NP65. [PMID: 28845750 DOI: 10.1177/2150135117706951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The choice of graft material for reconstruction of the vena cava in pediatric patients remains controversial. We successfully treated an eight-month-old female patient with single ventricle physiology and long segment obstruction of the left superior vena cava using the right superior vena cava autograft at the time of bilateral bidirectional superior cavopulmonary anastomosis. Postoperative computed tomography confirmed the patency of the reconstruction.
Collapse
Affiliation(s)
- Shuichi Shiraishi
- Division of Thoracic and Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
| | - Ai Sugimoto
- Division of Thoracic and Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
| | - Jiyong Moon
- Division of Thoracic and Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
| | - Masashi Takahashi
- Division of Thoracic and Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata City, Japan
| |
Collapse
|
22
|
Chen C, Xu L, Xu Y, Li P, Liu S, You B. Unroofed Coronary Sinus Syndrome: An Easily Corrected Congenital Anomaly But More Diagnostic Suspicion Is Needed. Heart Lung Circ 2017; 27:731-738. [PMID: 28709918 DOI: 10.1016/j.hlc.2017.05.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/13/2017] [Accepted: 05/27/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Unroofed coronary sinus syndrome (URCSS) is a spectrum of cardiac anomalies in which part (partial type) or the entire common wall (complete type) between the coronary sinus (CS) and left atrium is absent. It is commonly associated with a persistent left superior vena cava (PLSVC). The PLSVC can even anomalously connect to the left atrium in complete type anomaly. URCSS has been reported to be associated with delayed diagnosis and life-threatening cerebral injury. The purpose of the present study was to review our experience with surgical correction of this often-concealed malformation and discuss methods for reducing diagnostic omission. METHODS Thirty-six patients with URCSS who underwent surgical treatment from 1998 to 2015 in our institution were enrolled in this retrospective analysis. RESULTS The mean age of the patients was 21.8±20.9 years. Type I anomalies were found in 15 (41.7%) patients, type II in 4 (11.1%), type III in 6 (16.7%), and type IV in 11 (30.6%). A patient presenting with URCSS without other defects was identified in six (16.7%). One patient (2.8%) had a history of paradoxical embolisation. Twenty-five patients (69.4%) were diagnosed before surgery. Ten patients (27.8%) were diagnosed with URCSS intraoperatively. One patient (2.8%) was diagnosed with URCSS by follow-up echocardiography after device occlusion for atrial septal defect. Coronary sinus ostium dilation was the most important clue leading to partial type lesion disclosure intraoperatively. The anomalous PLSVC of 15 patients was repaired using roof tunnel technique in four (26.7%) cases, baffle redirection in eight (53.3%) cases, posterior left atrial wall plicating in two (13.3%) cases, and extracardiac bypass in one (6.7%) case. Postoperative complete atrioventricular block occurred in one patient (2.8%). One patient died postoperatively (2.8%). All patients are doing well after discharge from hospital. CONCLUSIONS Diagnostic suspicion can contribute to lesion disclosure. Surgical correction has good long-term outcomes and low risks.
Collapse
Affiliation(s)
- Changcheng Chen
- Department of Cardiac Surgery, Beijing Anzhen Hospital/Capital Medical University, Beijing, China.
| | - Lili Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital/Capital Medical University, Beijing, China
| | - Yi Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital/Capital Medical University, Beijing, China
| | - Ping Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital/Capital Medical University, Beijing, China
| | - Shuo Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital/Capital Medical University, Beijing, China
| | - Bin You
- Department of Cardiac Surgery, Beijing Anzhen Hospital/Capital Medical University, Beijing, China
| |
Collapse
|
23
|
Surgery for malignant lesions of the chest which extensively involved the mediastinum, lung, and heart. Gen Thorac Cardiovasc Surg 2017; 65:365-373. [PMID: 28540630 DOI: 10.1007/s11748-017-0782-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 05/10/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Radical resection for thoracic malignancies that invade the great vessels or heart structure is an uncommon, high-risk operation. To help surgeons determine therapeutic strategy, we reviewed the patient characteristics and outcomes of combined thoracic and cardiovascular surgery for thoracic malignancies. METHODS Surgical resections of lung cancer, mediastinal tumor and pulmonary artery sarcoma invading great vessels or heart structures were reviewed from the literature. RESULTS Pneumonectomy was often performed for lung cancer invading the aorta, superior vena cava, and left atrium. Complete resection (R0), no mediastinal lymph node metastasis and without using cardiopulmonary bypass led to a good prognosis. Induction therapy was often performed for complete resection. Regarding mediastinal tumors, thymic epithelial tumors or germ cell tumors occasionally invaded the great vessels or heart structures. For these malignancies, multimodality therapy was often performed, and complete resection could be one of the prognostic factors. The resection of primary pulmonary artery sarcoma (PPAS) is also a combined thoracic and cardiovascular surgery. The primary treatment for PPAS is surgical resection; specifically, pulmonary endarterectomy and pneumonectomy, because PPAS has substantial resistance to chemotherapy or radiotherapy. The prognosis of PPAS is poor, but surgical resection has potential for long-term survival. CONCLUSION Although these surgeries are uncommon and invasive for the patients, selecting appropriate patients, aggressive multimodality therapy, and performing combined thoracic and cardiovascular surgery can contribute to a good outcome.
Collapse
|
24
|
Zhang Z, Pan X, Qiu H, Guo T, Ou D, Ding H. [Application of vascular repair and reconstruction in surgical treatment of superior vena cava syndrome caused by thoracic tumor]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2017; 31:231-234. [PMID: 29786259 PMCID: PMC8458135 DOI: 10.7507/1002-1892.201610036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 12/26/2016] [Indexed: 11/03/2022]
Abstract
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.
Collapse
Affiliation(s)
- Zhenlong Zhang
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou Fujian 350001, P.R.China
| | - Xiaojie Pan
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou Fujian 350001,
| | - Hanfan Qiu
- Department of Cardiac Surgery, the Affiliated Union Hospital, Fujian Medical University, Fuzhou Fujian, 350001, P.R.China
| | - Tianxing Guo
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou Fujian 350001, P.R.China
| | - Debin Ou
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou Fujian 350001, P.R.China
| | - Hang Ding
- Department of Thoracic Surgery, Fujian Provincial Hospital, Fuzhou Fujian 350001, P.R.China
| |
Collapse
|
25
|
Thyroid carcinoma with extensive tumor thrombus in the superior vena cava: A case report. Int J Surg Case Rep 2016; 29:25-29. [PMID: 27810607 PMCID: PMC5094151 DOI: 10.1016/j.ijscr.2016.10.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/15/2016] [Accepted: 10/15/2016] [Indexed: 12/17/2022] Open
Abstract
This is an uncommon surgical case report of thyroid carcinoma with extensive tumor thrombus in the superior vena cava. Management criteria for thyroid carcinoma with venous tumor thrombus is considered for safe and effective operation. Treatment and natural history for pulmonary infarction that occurred for drop off of the tumor thrombus are recognizable.
Introduction Venous tumor thrombus of thyroid cancer that extend to the great vein is rare, and management criteria for venous thrombus have not been established yet. We report a surgical case of thyroid carcinoma with extensive tumor thrombus in the superior vena cava (SVC) and consider the appropriate treatment strategy for venous thrombus. Presentation of case A 75-year-old woman consulted our hospital because of thyroid carcinoma with an extensive tumor thrombus. Computed tomography (CT) revealed a solitary thyroid mass with extensive continuous tumor thrombus in the left internal jugular vein, innominate vein, and SVC. We planned complete tumor resection. During operation, the tumor thrombus in the SVC disappeared, suggesting that pulmonary embolism occurred. Therefore, she underwent total thyroidectomy with extensive phlebectomy (the innominate and internal jugular veins). Although she had some morbidities during her postoperative course, she was followed up for 6 months without progression of thyroid cancer. Discussion and conclusion Intravascular tumor extension of thyroid carcinoma is rare, but is a life-threatening complication. For patients with thyroid tumor with venous tumor thrombus, segmental resection and thrombectomy should be considered if radical operation is possible. Therefore, preoperative correct imaging evaluation and operative planning are necessary to perform safe and effective operations. We suggest a management criteria for patients with thyroid carcinoma with venous tumor thrombus.
Collapse
|
26
|
Haruki T, Wakahara M, Taniguchi Y, Nakamura Y, Nishimura M, Nakamura H. Successful multimodality treatment for locally advanced primary thymic adenocarcinoma: report of a case. J Surg Case Rep 2016; 2016:rjw148. [PMID: 27605661 PMCID: PMC5635608 DOI: 10.1093/jscr/rjw148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although the optimal treatment strategy for locally advanced thymic carcinomas has yet to be determined, complete resection of the tumor after induction chemoradiotherapy (CRT) can sometimes provide a good chance of being cured. A 61-year-old woman was diagnosed with locally advanced primary thymic carcinoma, which invaded bilateral brachiocephalic veins and superior vena cava with intraluminal tumor thrombus. Induction CRT was performed, and a partial response to the treatment was achieved. Subsequent radical surgery was successfully performed by the median full sternotomy with a right transmanubrial osteomuscular sparing approach (TMA). The patient is currently alive and has remained disease-free for a year. The TMA is useful for extensive surgery of locally advanced thymic carcinoma because it can provide good exposure of the operative field without post-operative functional limitation of upper limbs.
Collapse
Affiliation(s)
- Tomohiro Haruki
- Division of General Thoracic Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan,
| | - Makoto Wakahara
- Division of General Thoracic Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yuji Taniguchi
- Division of General Thoracic Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yoshinobu Nakamura
- Division of Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Motonobu Nishimura
- Division of Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hiroshige Nakamura
- Division of General Thoracic Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| |
Collapse
|
27
|
Oizumi H, Suzuki K, Banno T, Matsunaga T, Oh S, Takamochi K. Patency of grafts after total resection and reconstruction of the superior vena cava for thoracic malignancy. Surg Today 2016; 46:1421-1426. [DOI: 10.1007/s00595-016-1347-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 02/25/2016] [Indexed: 11/30/2022]
|
28
|
Temporary extravascular shunt for reconstruction of a superior vena cava invaded by a lung tumor. Ann Thorac Surg 2014; 98:2242-3. [PMID: 25468109 DOI: 10.1016/j.athoracsur.2014.06.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 05/01/2014] [Accepted: 06/11/2014] [Indexed: 11/21/2022]
Abstract
Advanced central lung cancers can invade the superior vena cava (SVC). Although the indications for resection of the vessel remain controversial, it has been suggested that it increases the long-term survival of selected patients; however, little consensus has been reached regarding the optimal method of vascular reconstruction. While the SVC is often replaced during unprotected cross-clamp, the placement of a temporary venous shunt with a view to preserve the periprocedural safety and facilitate the postoperative management seems preferable. We describe an SVC reconstruction procedure using an autologous pericardial patch and placement of a temporary extravascular shunt via a lateral thoracotomy.
Collapse
|
29
|
Labarca E, Zapico A, Ríos B, Martinez F, Santamarina M. Superior vena cava syndrome due to a leiomyosarcoma of the anterior mediastinum: A case report and literature overview. Int J Surg Case Rep 2014; 5:984-7. [PMID: 25460453 PMCID: PMC4276077 DOI: 10.1016/j.ijscr.2014.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 09/25/2014] [Accepted: 10/09/2014] [Indexed: 12/12/2022] Open
Abstract
Leiomyosarcomas are rare causes of superior vena cava syndrome. Surgery is the treatment of choice. Specific approaches depend on the neoplasm's size and invasion of neighbouring tissues.
INTRODUCTION Leiomyosarcomas are an infrequent cause of malignant superior vena cava syndrome (VCS). PRESENTATION OF CASE A 51-year old male patient was admitted for a three-day history of dyspnoea, dysphagia and erythema of the head and neck. Computed tomography and magnetic resonance imaging showed a lesion arising on the anterior mediastinum, which was in close proximity with a thrombus in the superior vena cava. Surgical excision was performed, including open resection of the primary tumour and an atrio-innominate vein bypass with 8-mm polytetrafluoroethylene (PTFE). Histology confirmed a leiomyosarcoma and postoperative radiotherapy sessions were performed. Due to evidence of enlargement of the thrombus, a second intervention was undertaken. In this procedure, a remainder of the primary tumour was resected and the superior vena cava reconstructed with an autologous pericardium patch. The patient recovered satisfactorily and was discharged on the seventh postoperative day, with no evidence for relapse after 10 months of follow-up. DISCUSSION Leiomyosarcomas comprise less than 2% of the tumours of the mediastinum and are a rare cause of paraneoplastic VCS. Male patients in their sixties are most commonly affected. Relapses seem to be common, and thus a careful follow-up is often recommended. CONCLUSION In spite of the limited data on the management of thoracic leiomyosarcomas, surgery is currently considered the mainstay of treatment.
Collapse
Affiliation(s)
- E Labarca
- Departamento de Cirugía Vascular, Hospital Naval Almirante Nef, Viña del Mar, Chile.
| | - A Zapico
- Departamento de Cirugía Cardiaca, Hospital Naval Almirante Nef, Viña del Mar, Chile
| | - B Ríos
- cultad de Medicina, Universidad Andrés Bello, Viña del mar, Chile
| | - F Martinez
- entro de Investigaciones Biomédicas, Escuela de Medicina, Universidad de Valparaíso, Chile
| | - M Santamarina
- Departamento de Imagenología, Hospital Naval Almirante Nef, Viña del Mar, Chile
| |
Collapse
|
30
|
Abstract
Lung cancer with involvement of the SVC is uncommon but presents a unique management challenge. Discovery of N2 disease should be given its due diligence and these patients should undergo induction therapy. Patients can attain favorable long-term outcomes with surgery, but they need to be carefully selected at specialized centers.
Collapse
Affiliation(s)
- Dong-Seok D Lee
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1023, New York, NY 10029, USA.
| | - Raja M Flores
- Department of Thoracic Surgery, Mount Sinai Health System, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1023, New York, NY 10029, USA
| |
Collapse
|
31
|
Ohta M, Okura E, Fukui E, Kitahara N, Kadota Y. Simple technique for reconstruction of superior vena cava and brachiocephalic vein after removal for thoracic malignancies. Ann Thorac Surg 2014; 97:2171-3. [PMID: 24882297 DOI: 10.1016/j.athoracsur.2013.07.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 06/30/2013] [Accepted: 07/09/2013] [Indexed: 11/18/2022]
Abstract
A ringed polytetrafluoroethylene graft was applied to reduce clamping time for a patent major vein. In case 1, after suturing the ringed graft to the right appendage, the other end was inserted in the distal direction of the left brachiocephalic vein and secured by ligation. In case 2, to repair an extensive superior vena cava defect, the graft was wrapped with the remnant venous wall and fixed with a continuous suture. Only 5 minutes were required to reconstruct the left brachiocephalic vein and 20 minutes for the superior vena cava. Long-term graft patency was obtained without thrombosis.
Collapse
Affiliation(s)
- Mitsunori Ohta
- Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan.
| | - Eiji Okura
- Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
| | - Eriko Fukui
- Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
| | - Naoto Kitahara
- Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
| | - Yoshihisa Kadota
- Department of General Thoracic Surgery, Osaka Prefectural Medical Center for Respiratory and Allergic Disease, Osaka, Japan
| |
Collapse
|
32
|
Braga SF, Brandão D, Sousa PP, Campos J, Canedo A, Brandão P, Mota JC, Vouga L. Síndrome da veia cava superior: caso clínico. ANGIOLOGIA E CIRURGIA VASCULAR 2014. [DOI: 10.1016/s1646-706x(14)70026-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
33
|
Benkirane A, Khodari M, Yakoubi R, Lambert M, Koussa M, Ghoneim T, Haulon S, Villers A, Lemaitre L, Zini L. Polytetrafluoroethylene expanded prosthesis as replacement of the inferior vena cava in renal cell carcinoma with caval thrombus. Int J Urol 2014; 21:448-52. [DOI: 10.1111/iju.12339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 10/14/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Ahmed Benkirane
- Department of Urology; University of Lille Nord de France; Lille France
| | | | - Rachid Yakoubi
- Department of Urology; University of Lille Nord de France; Lille France
| | - Marc Lambert
- Department of Internal Medicine; University of Lille Nord de France; Lille France
| | - Mohamad Koussa
- Department of Vascular Surgery; University of Lille Nord de France; Lille France
| | - Tarek Ghoneim
- Department of Urology; University of Lille Nord de France; Lille France
| | - Stephan Haulon
- Department of Vascular Surgery; University of Lille Nord de France; Lille France
| | - Arnauld Villers
- Department of Urology; University of Lille Nord de France; Lille France
| | - Laurent Lemaitre
- Department of Radiology; University of Lille Nord de France; Lille France
| | - Laurent Zini
- Department of Urology; University of Lille Nord de France; Lille France
| |
Collapse
|
34
|
D'Andrilli A, De Cecco CN, Maurizi G, Muscogiuri G, Baldini R, David V, Venuta F, Rendina EA. Reconstruction of the superior vena cava by biologic conduit: assessment of long-term patency by magnetic resonance imaging. Ann Thorac Surg 2013; 96:1039-45. [PMID: 23791160 DOI: 10.1016/j.athoracsur.2013.04.062] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Revised: 04/16/2013] [Accepted: 04/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND To assess the long-term patency of the biologic prosthetic conduit used for reconstruction of the superior vena cava (SVC) by magnetic resonance imaging (MRI). METHODS Patients undergoing oncologic resection and reconstruction of the SVC by a bovine pericardial prosthesis (January 2003 to April 2010) have been studied after 1 year (if surviving) by MRI for the assessment of the conduit long-term patency. Results were compared with those of a control group of patients with normal SVC. Blood flow and area of lumen section at 3 different levels (proximal, middle, distal) were analyzed. RESULTS Sixteen consecutive patients surviving after 1 year from surgery out of 17 (9 lung cancer, 8 mediastinal malignancy) undergoing SVC reconstruction were included. One patient died postoperatively and was not included. Sixteen patients with similar demographic characteristics were studied in the control group. Mean blood flow was 18.4±3.5 mL/sec (range 14.3 to 25.7) in patients with reconstructed SVC and 20.8±4.1 mL/sec (range 15.3 to 27.7) in the control group. Mean area of the conduit lumen section was 2.2±0.6 cm2 (range 1.6 to 3.6) at proximal level, 2.9±1.3 cm2 at middle level (range 1.3 to 5.7), and 2.1±0.9 cm2 (range 0.5 to 4) at distal level in the reconstructed group, and 2.6±0.7 cm2 (range 1.8 to 4.2), 2.7±0.7 cm2 (range 1.9 to 4.3), and 2.4±0.3 cm2 (range 1.8 to 3.1), respectively, at proximal, middle, and distal levels in the control group. Differences between the 2 groups were not significant (p>0.05). CONCLUSIONS The MRI assessment in terms of blood flow and area of lumen section at 3 different levels confirms that bovine pericardial conduit used for SVC replacement shows an optimal patency over the long term.
Collapse
Affiliation(s)
- Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, Sapienza University, Rome, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Itoda Y, Komae H, Yamamoto T, Takeda M. Aortic pseudoaneurysm due to graft infection after invasive thymoma resection. Asian Cardiovasc Thorac Ann 2012; 20:584-6. [PMID: 23087306 DOI: 10.1177/0218492312437616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 69-year-old woman with invasive thymoma underwent chemoradiotherapy followed by surgical resection, including extended thymectomy, right upper lobectomy, and innominate vein and superior vena cava reconstruction with a polytetrafluoroethylene graft. Computed tomography on the 27th postoperative day revealed mediastinitis and right hemothorax; open debridement and evacuation were performed. Vacuum-assisted closure was initiated to heal the median incision. The wound gradually cleared, and the vacuum was terminated on the 150th postoperative day. On the 155th postoperative day, the patient suffered a sudden hemorrhage from the anterior thoracic wall. Computed tomography revealed a ruptured ascending aortic pseudoaneurysm surrounding the graft.
Collapse
Affiliation(s)
- Yoshifumi Itoda
- Department of Cardiac Surgery, Asahi General Hospital, Chiba, Japan.
| | | | | | | |
Collapse
|
36
|
Bendel EC, Maleszewski JJ, Araoz PA. Imaging sarcomas of the great vessels and heart. Semin Ultrasound CT MR 2012; 32:377-404. [PMID: 21963161 DOI: 10.1053/j.sult.2011.06.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Primary sarcomas of the aorta, pulmonary artery, superior vena cava, inferior vena cava, and the heart are rare neoplasms. Aortic sarcomas are broadly categorized as either primarily luminal or primarily mural, with luminal sarcomas more likely to be misdiagnosed as thrombus. Pulmonary artery sarcomas are often mistaken for pulmonary embolism both clinically and at imaging. Vena caval sarcomas appear as intraluminal or extraluminal masses connecting to or filling the veins. The most common are leiomyosarcomas of the inferior vena cava. Primary sarcomas of the heart are rare and usually appear as heterogeneous aggressive masses.
Collapse
Affiliation(s)
- Emily C Bendel
- Department of Diagnostic Radiology, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | | | | |
Collapse
|
37
|
D'Andrilli A, Venuta F, Menna C, Rendina EA. Extensive resections: pancoast tumors, chest wall resections, en bloc vascular resections. Surg Oncol Clin N Am 2012; 20:733-56. [PMID: 21986269 DOI: 10.1016/j.soc.2011.07.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Infiltration by lung tumor of adjacent anatomic structures including major vessels, main bronchi, and chest wall not only influences the oncologic severity of the disease but also increases the technical complexity of surgery, requiring extended resections and demanding reconstructive procedures. Completeness of resection represents in every case one of the main factors influencing the long-term outcome of patients. Technical and oncologic aspects of extended operations, including resection of Pancoast tumors and chest wall, bronchovascular sleeve resections, and en bloc resections of major thoracic vessels, are reported in this article.
Collapse
Affiliation(s)
- Antonio D'Andrilli
- Department of Thoracic Surgery, Sant'Andrea Hospital, University LaSapienza, Via di Grottarossa 1035, 00189 Rome, Italy.
| | | | | | | |
Collapse
|
38
|
Jaus M, Macchiarini P. Superior Vena Cava and Innominate Vein Reconstruction in Thoracic Malignancies: Cryopreserved Graft Reconstruction. Semin Thorac Cardiovasc Surg 2011; 23:330-5. [DOI: 10.1053/j.semtcvs.2012.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2012] [Indexed: 11/11/2022]
|
39
|
Odell DD, Liao K. Superior Vena Cava and Innominate Vein Reconstruction in Thoracic Malignancies: Double-Vein Reconstruction. Semin Thorac Cardiovasc Surg 2011; 23:326-9. [DOI: 10.1053/j.semtcvs.2012.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2012] [Indexed: 11/11/2022]
|
40
|
Andrade RS. Introduction: superior vena cava and innominate vein reconstruction in thoracic malignancies. Semin Thorac Cardiovasc Surg 2011; 23:322. [PMID: 22443653 DOI: 10.1053/j.semtcvs.2012.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rafael S Andrade
- Division of General Thoracic and Foregut Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA.
| |
Collapse
|