Extended operation for lung cancer invading the superior vena cava

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.