Superior vena cava resection for lung and mediastinal malignancies

Even though the benefit of superior vena cava resection for lung and mediastinal malignancies remains controversial, the recent international experiences have demonstrated technical feasibility of such an extended surgery with acceptable postoperative morbidity and mortality. Concerning lung cancer, a multicentric international study over a 40-year period reports a risk of developing postoperative complications and mortality of 30% and 12%, respectively, with a 5-year probability of survival of 21%. The same study, analysing the results of the last 10 years, demonstrated an improvement of the outcome with a 6% of postoperative mortality, with a 5-year probability of survival of 28%. With regards to mediastinal malignancies, completeness of surgical resection is still considered one of the most important prognostic factors, and extended SVC resection could improve local control and disease free survival. In conclusion, radical resection of lung cancer and mediastinal malignancies involving SVC, is feasible, and it could lead to permanent cure in carefully selected patients.