Outcomes of surgical reconstruction of the superior vena cava syndrome in patients with locally advanced thymomas

Abstract

The aim of the study: to study and demonstrate the potential and technical aspects of the surgical treatment of locally advanced thymus tumours with the tumour infiltrate affecting superior vena cava and its branches. Methods. 56 patients with locally advanced thymomas complicated by SVCS were study. The control group included 30 patients with SVCS were treated with conventional techniques, while the experimental group included 26 patients who underwent a novel bypass surgery developed by us. Results. Based on our observations, patients tolerated these surgeries much better. The venous bypass was mandatorily complemented with cytoreduction. Auriculo-jugular (left and right) and auriculo-subclavian (left and right) bypasses were used in our observations Complications in the post-operative period were reported from the experimental group and included auriculo-subclavian bypass thrombosis, post-operative complications were reported in the control group including haemorrhage from the sternotomy wound in 1 (3.3 %) case, superior vena cava thrombosis in 2 (6.6 %) cases, pneumonia in 2 (6.6 %) cases and thromboembolism of small pulmonary arteries in 2 (6.6 %) cases. Post-operative lethality in the study groups was reported in the control and in the experimental group. Total lethality rate was 8.9 % (5 patients). The relative risk of complications and lethal outcome was calculated for patients from both groups. It was found that the risk of complications was twice as high in the control group as in the experimental group (standard error of relative risk equals 0.64), whereas the risk of lethal outcome increased by a factor of 3.5 in the control group (standard error of relative risk equals 1.09) Conclusion. It has been established that the superior vena cava syndrome in patients with locally advanced thymoma is an emergency condition whose surgical correction must be personalised depending on the anatomic and topographic classification of SVC lesion types. It is known that an obligatory pre-condition of the perioperative period in this category of patients is an adequate vascular approach to the superior vena cava system. The first mandatory step of the radical surgery in patients with locally advanced thymomas with SVC invasion should be the auriculo-jugular and auriculo-subclavian bypasses, which can reduce the relative risk of post-operative complications by a factor of the risk of lethal by a factor of 3.5.