Bio-materials and surgical options for the treatment of lung cancer invading the superior vena cava.

Background. The oncologic value of superior vena cava (SVC) resection for lung malignancies remains controversial. The aim of this study was to review postoperative outcome and long-term oncologic results in the surgical treatment of locally advanced lung cancer (NSCLC) invading the SVC system. Methods. The clinical data of 88 consecutive patients who underwent surgery for locally advanced NSCLC invading SVC system from 1998 to november 2011 were retrospectively reviewed. Patients were grouped according to the type of surgical treatment performed. The study endpoints were overall survival, post-operative morbidity, mortality and lenght of postoperative stay. Results. Forty-seven (72.4%) patient underwent partial SVC resection. Replacement of the SVC system by prosthesis was performed in 18 patients (27.6%). In 20 patients (30.7%) SVC resection was associated with carina resection (SVC-CR). In 23 patients a replacement of the SVC was performed by a biomaterial: polytetrafluoroethylene graft (13 patients), biological custom-made bovine pericardial tube (14 patients) or autologus pericardium patch (5 patients). Twenty-three patients underwent explorative thoracotomy (ET). In the resected group overall postoperative major morbidity and mortality rates were 17% (minor 28%, major 16%) and 9,2% respectively. In multivariate analysis, advanced age (≥60 years) and advanced stage (III-IV) are independent predictors of survival. Mortality was not influenced by any factor. Five-year survival probability was 25% for overall SVC resection, and 20% when resection of SVC was associated with CR. In SVC resection patients, lymph node status was the most important prognostic factor of survival (5-year survival in N0 patients 44%; 22% in N+). In ET group 5-year survival was 12%. Conclusions. Pursuing extended resection in locally advanced NSCLC invading SVC may achieve permanent cure in selected patients who would otherwise be defined inoperable with very poor prognosis. Satisfactory long-term results in NSCLC infiltrating the SVC system can be achieved only when pathologic N2 disease is excluded.