Combined resection of superior vena cava for lung carcinoma: Prognostic significance of patterns of superior vena cava invasion

Background Combined resection of the superior vena cava (SVC) for lung carcinoma remains challenging in terms of technical aspect and prognosis. We attempted to clarify the surgical outcome of combined resection and reconstruction of the SVC for lung carcinoma. Methods Between March 1980 and May 2001, among 3,499 lung resections, 40 (1.1%) patients underwent combined resection of the SVC. Thirty-four were men and 6 were women. Ages ranged from 37 to 77 years, with median of 64 years. Lobectomy and pneumonectomy was performed in 19 and 21 patients, respectively. The SVC system was totally resected and reconstructed with grafts in 11 patients, and partially resected in 29 patients. For the latter patients, autologous pericardial patches were used in 8 patients, and a running direct suture was performed in 21 patients. The survival curves were constructed by the method of Kaplan-Meier, and the curves were compared using the log-rank test. Results Thirty-day mortality was 10%. The 5-year survival rate was 24%, with the median follow-up period for living patients 67 months (actual 5-year survivors were 7). The prognoses were compared between patients with SVC invasion by metastatic nodes (n = 15) and those with SVC invasion by a direct tumor extension (n = 25), and the survival difference was statistically significant (5-year survival rate, 6.6% versus 36%; p = 0.05). Conclusions The pattern of SVC invasion was considered to be a significant prognostic factor, and this factor should be taken into consideration for evaluating the outcome of clinical trials for T4 lung cancer.