10 years single center experience with resection of the superior vena cava in locally advanced non-small cell lung cancer

Background:

In patients with locally advanced T4 non-small cell lung cancer (NSCLC) invading the superior vena cava (SVC), combined multimodality treatment including surgery is indicated. However, this treatment approach warrants careful patient selection and adequate postoperative management. We aim to review our institutional experience with SVC resection in advanced NSCLC.

Material and method:

Between 2006 and 2017, surgery for NSCLC including SVC resection has been performed in 21 patients at our department. We defined “SVC resection” as resection of the SVC and replacement with ring-enforced tube grafts and “SVC reconstruction” as partial resection with direct closure or reconstruction with a bovine pericardial patch. Clinical parameters and long-term outcome were analyzed.

Result:

Overall, 15 male and 6 female patients have been included. Induction treatment was performed in 16 patients, 8 patients received chemoradiation therapy and the other 8 patients had chemotherapy alone. Pulmonary resection included 8 sleeve pneumonectomies, 4 pneumonectomies, 3 lobectomies and 4 sleeve-lobectomies of the right upper lobe, 1 extraanatomical resection of the right upper lobe and one mediastinal tumor debulking. Two patients required cardiopulmonary bypass during surgery. An extended resection including the carina (n = 1), thoracic wall (n = 1), phrenic nerve (n = 3) pericardium or right atrium (n = 4) was performed in 9 patients. Overall 5 patients underwent SVC reconstruction whereas 16 patients had complete SVC resection and replacement. The 90-day-mortality rate was 4,8% (n = 1). Major complications occurred in 8 patients (38%) with no difference between patients undergoing SVC resection or reconstruction. Oncological long-term outcome will be presented at the conference.

Conclusion:

Our results suggest that an extended resection including SVC replacement or reconstruction is a feasible and safe procedure for carefully selected patients with NSCLC and SVC involvement with acceptable postoperative morbidity and mortality rates.