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The journal «ONCOSURGERY» 2013, Vol.5, No 2

Circumferential inferior vena cava resection without prosthesis in patients with mediastinal tumor complicated by mediastinal compression syndrome

Pikin ОV, Trakhtenberg АKh, Kolbanov КI, Glushko VА, Kazakevich VI, Amiraliev АM, Vursol DА, Kirsanova ОN

PA Herzen Moscow Cancer Research Institute, Moscow, Russia
Contact: Pikin Oleg Valentinovich, e-mail:

Relevance. For patients with mediastinal tumor representing by syndrome of superior vena cava (SVC) compression after non-surgical treatment indications for circumferential resection of SVC may arise during the operation. For continuous SVC compression syndrome and well-developed collaterals the prosthesis is contraindicated due to extremely high risk of prosthetic thrombosis. In this situation circumferential resection of SVC and its branches is feasible.

Material and methods. In the department of thoracic surgery in P.A. Herzen MCRI circumferential resection of SVC without prosthesis was performed in 3 patients with mediastinal tumor, complicated by continuous SVC compression syndrome. All patients had polychemotherapy at first stage of treatment according to histological type of tumor. Complete longitudinal sternotomy was performed in all cases. Mediastinal tumor removal was associated with circumferential resection of SVC and brachiocephalic veins, pericardium, lung and in one patient – with right-sided superior bilobectomy. The decision for circumferential SVC resection was made after previous compression of its influents with no signs of acute SVC syndrome, representing compensation of collateral circulation. One patient had total removal of SVC, the azygos vein confluence was preserved in two patients.

Results. There were no severe postoperative complications and death. The patient with germ cell tumor died 18 months after surgery due to tumor progression, others were alive for 32 and 38 months with no signs of recurrence.

Conclusion. The circular SVC resection for continuous compression syndrome is safe due to compensation of collateral circulation.

KEY WORDS: mediastinal compression syndrome; circumferential superior vena cava resection.

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