Background: Advanced-stage thymic tumors infiltrating the superior vena cava (SVC), when radically resectable, can be surgically treated by SVC prosthetic replacement within a multimodality therapeutic approach. We hereby present our series of patients undergoing SVC resection and prosthetic reconstruction for stage III or IV thymic malignancies. Methods: Between 1989 and 2015, 27 patients with thymic tumors (21 thymoma, 6 thymic carcinoma) infiltrating the SVC underwent radical resection with a SVC prosthetic replacement by a bovine pericardial conduit in 12 cases, a polytetrafluoroethylene conduit in 13, a porcine pericardial conduit in 1, and a saphenous vein conduit in 1. All the patients underwent vascular conduit reconstruction by the cross-clamping technique. Results: Six patients were myasthenic. All resections were complete (R0). Twelve patients received induction treatment. Pulmonary resection was associated in 16 patients (11 wedge, 5 pneumonectomy). Twenty-two patients were Masaoka stage III and 5 were stage IVa. Mortality rate was 7.4%; no mortality was related to the vascular reconstruction. Major complication rate was 11.1%. At a median follow-up of 58 (range, 4 to 134) months, recurrence occurred in 9 (36%) patients. Three- and 5-year overall survival rates were 80% and 58.1%, respectively. Three-and 5-year cancer-specific survival were 90.5% and 75.4%. Cancer-specific survival rates of thymoma patients at 5 years were 93.8%. Five-year cancer-specific survival of all stage III patients was 77.1%. Thymic carcinoma histology was a negative prognostic factor. Long-term patency of the pericardial conduits was 100%. Conclusions: En bloc resection and conduit reconstruction of the SVC is a good option to allow radical resection of locally advanced thymic tumors. A heterologous pericardial conduit represents the favorite option in our experience.

Superior vena cava replacement for thymic malignancies / Maurizi, Giulio; Poggi, Camilla; D'Andrilli, Antonio; Vanni, Camilla; Ciccone, Annamaria; Ibrahim, Mohsen; Andreetti, Claudio; Tierno, SIMONE MARIA; Venuta, Federico; Rendina, Erino Angelo. - In: ANNALS OF THORACIC SURGERY. - ISSN 0003-4975. - 107:2(2019), pp. 386-392. [10.1016/j.athoracsur.2018.08.060]

Superior vena cava replacement for thymic malignancies

Maurizi Giulio;Poggi Camilla;D'Andrilli Antonio;Vanni Camilla;Ciccone Anna Maria;Ibrahim Mohsen;Andreetti Claudio;Tierno Simone Maria;Venuta Federico;Rendina Erino Angelo
2019

Abstract

Background: Advanced-stage thymic tumors infiltrating the superior vena cava (SVC), when radically resectable, can be surgically treated by SVC prosthetic replacement within a multimodality therapeutic approach. We hereby present our series of patients undergoing SVC resection and prosthetic reconstruction for stage III or IV thymic malignancies. Methods: Between 1989 and 2015, 27 patients with thymic tumors (21 thymoma, 6 thymic carcinoma) infiltrating the SVC underwent radical resection with a SVC prosthetic replacement by a bovine pericardial conduit in 12 cases, a polytetrafluoroethylene conduit in 13, a porcine pericardial conduit in 1, and a saphenous vein conduit in 1. All the patients underwent vascular conduit reconstruction by the cross-clamping technique. Results: Six patients were myasthenic. All resections were complete (R0). Twelve patients received induction treatment. Pulmonary resection was associated in 16 patients (11 wedge, 5 pneumonectomy). Twenty-two patients were Masaoka stage III and 5 were stage IVa. Mortality rate was 7.4%; no mortality was related to the vascular reconstruction. Major complication rate was 11.1%. At a median follow-up of 58 (range, 4 to 134) months, recurrence occurred in 9 (36%) patients. Three- and 5-year overall survival rates were 80% and 58.1%, respectively. Three-and 5-year cancer-specific survival were 90.5% and 75.4%. Cancer-specific survival rates of thymoma patients at 5 years were 93.8%. Five-year cancer-specific survival of all stage III patients was 77.1%. Thymic carcinoma histology was a negative prognostic factor. Long-term patency of the pericardial conduits was 100%. Conclusions: En bloc resection and conduit reconstruction of the SVC is a good option to allow radical resection of locally advanced thymic tumors. A heterologous pericardial conduit represents the favorite option in our experience.
2019
adult; aged; aortic clamping; article; cancer prognosis; cancer recurrence; cancer specific survival; cancer surgery; cancer survival; chemoradiotherapy; chylothorax; clinical article; female; follow up; histopathology; human; human tissue; low drug dose; lung edema; lung embolism; lung resection; male; neoadjuvant chemotherapy; overall survival; priority journal; prosthetic replacement; radical resection; recurrent disease; respiratory failure; saphenous vein; superior cava vein; thymoma; thymus cancer; tracheostomy; vascular surgery; wedge resectio
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Superior vena cava replacement for thymic malignancies / Maurizi, Giulio; Poggi, Camilla; D'Andrilli, Antonio; Vanni, Camilla; Ciccone, Annamaria; Ibrahim, Mohsen; Andreetti, Claudio; Tierno, SIMONE MARIA; Venuta, Federico; Rendina, Erino Angelo. - In: ANNALS OF THORACIC SURGERY. - ISSN 0003-4975. - 107:2(2019), pp. 386-392. [10.1016/j.athoracsur.2018.08.060]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1263354
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