Patency of grafts after total resection and reconstruction of the superior vena cava for thoracic malignancy.

Objective: Resection and reconstruction of the superior vena cava (SVC) is used for the complete resection of advanced lung cancer and mediastinal tumors. However, the optimal postoperative management for this procedure remains to be elucidated.

Methods: 1897 patients with lung cancer and/or mediastinal tumors underwent surgical resection at our institute. Among them, 12 patients underwent combined resection and replacement with a vascular graft of the SVC. Preoperative SVC syndrome was noted in 4, and preoperative chemo and/or radiotherapy were used in 2. The SVC pathway was reconstructed bilaterally in 9 patients (75 %), while 2 patients underwent a right-side single bypass, and 1 had a Y-shaped bypass. Antithrombotic agents were not used postoperatively. The factors related to occlusion of the graft were investigated. The median follow-up time for the surviving patients was 474 days.

Results: There were no instances of surgical mortality. Among the 22 grafts, three (14 %) were occluded. One (8 %) case of occlusion was noted on the right side and 2 (20 %) in the left graft. Bilateral reconstruction was performed in all except 2. Two single side reconstructions did not result in occlusion, while 3 occlusions were noted in the patients who had undergone bilateral reconstruction.

Conclusions: Resection and reconstruction of the SVC system was feasible. Postoperative anti-thrombotic agents are not always needed to prevent acute graft occlusion.