TECHNICAL OPTIONS IN RECONSTRUCTION OF THE SUPERIOR VENA CAVA ASSOCIATED WITH INVASIVE THYMIC TUMOR

概要

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Six patients who underwent a reconstruction of the superior vena cava (SVC) area were reviewed. The mean age of the patients was 50 years. Only one patient complained of preoperative SVC syndrome. Pathologic diagnoses were invasive thymoma in five patients including two redo cases, and thymic carcinoid tumor in one patient. Polytetrafluoroethylene (EPTFE) grafts were used for vein reconstruction. The left innominate vein was reconstructed in all six patients. The right innominate vein and the SVC were reconstructed in three patients. Extracorporeal circulation (ECC) was used in one patient with a tumor extension into the right atrium. All patients except for one with a thymic carcinoid tumor received both postoperative irradiation therapy and chemotherapy. Two patients died during the postoperative late periods and four patients survived for three to 18 years (mean ; 10) after the initial operation. Three out of four patients underwent additional surgery during the postoperative late periods. The graft patency rate was 67 % in the SVC area and 50% in the left innominate veins. In conclusion, a radical operation with reconstruction of SVC is treatment of choice for long-term survival and bilateralvenous reconstruction is recommended The indication of ECC for tumor resection is still controversial.