Thomas P, Magnan P E, Moulin G, Giudicelli R, Fuentes P
Department of Thoracic Surgery, Sainte-Marguerite Hospital, Marseilles, France.
Eur J Cardiothorac Surg. 1994;8(4):177-82. doi: 10.1016/1010-7940(94)90111-2.
Between 1981 and 1991, 845 patients were operated on for right lung cancer. Among them, 50 (6%) had a tumor invading the superior vena cava (SVC). Fifteen patients (14 men and 1 woman, mean age: 58 years) underwent radical resection with concomitant vascular reconstruction. Two patients presented with a superior vena caval syndrome. The SVC was invaded by direct extension from the tumor (n = 11) or by paratracheal nodal involvement (n = 4). The patients required pneumonectomy (n = 13) or upper lobectomy (n = 2), with lateral (n = 11) or circumferential resection (n = 4) of the SVC. The venous pathway was repaired by direct suture (n = 9), prosthetic patch (n = 2) or polytetrafluoroethylene (PTFE) graft (n = 4). Tumor resection was considered macroscopically complete in 12 patients (80%). One patient died postoperatively (7%) and non-fatal complications occurred in 3 (20%). Early patency of the four grafts was assessed by phlebography. In the late course, pulmonary embolism occurred in two patients and extended superior vena caval thrombosis in one; the overall clinical patency rate was 75.7% at 1 and 5 years. Two patients (13.3%) experienced mediastinal recurrence; the overall survival rates at 1 year, 2 years and 5 years were, respectively, 46.7%, 32% and 24% (median: 8.5 months). We conclude that extended resection for lung cancer invading the SVC, when feasible, is justified given the effective control of the primary tumor thereby provided, with an acceptable operative risk.
1981年至1991年间，845例患者接受了右肺癌手术。其中，50例（6%）肿瘤侵犯上腔静脉（SVC）。15例患者（14例男性和1例女性，平均年龄：58岁）接受了根治性切除并同期进行血管重建。2例患者出现上腔静脉综合征。SVC受肿瘤直接侵犯（n = 11）或气管旁淋巴结受累（n = 4）。患者需要进行全肺切除术（n = 13）或上叶切除术（n = 2），同时对SVC进行外侧（n = 11）或环形切除（n = 4）。静脉通路通过直接缝合（n = 9）、人工补片（n = 2）或聚四氟乙烯（PTFE）移植物（n = 4）进行修复。12例患者（80%）的肿瘤切除在宏观上被认为是完整的。1例患者术后死亡（7%），3例（20%）发生非致命性并发症。通过静脉造影评估4例移植物的早期通畅情况。在后期，2例患者发生肺栓塞，1例发生上腔静脉血栓形成；1年和5年时的总体临床通畅率为75.7%。2例患者（13.3%）出现纵隔复发；1年、2年和5年的总体生存率分别为46.7%、32%和24%（中位数：8.5个月）。我们得出结论，对于侵犯SVC的肺癌，在可行的情况下进行扩大切除是合理的，因为这样可以有效控制原发肿瘤，且手术风险可接受。
