Outcomes of surgical reconstruction of the superior vena cava syndrome in patients with locally advanced thymomas
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.
Khaki, F., Javanbakht, J., Sasani, F., Gharagozlou, M. J., Bahrami, A., Moslemzadeh, H., Sheikhzadeh, R. (2013). Cervical type AB thymoma (Mixed) tumour diagnosis in a mynah as a model to study human: clinicohistological, immunohistochemical and cytohistopathological study. Diagnostic Pathology, 8 (1). doi: http://doi.org/10.1186/1746-1596-8-98
Giannopoulou, A., Gkiozos, I., Harrington, K. J., Syrigos, K. N. (2013). Thymoma and radiation therapy: a systematic review of medical treatment. Expert Review of Anticancer Therapy, 13 (6), 759–766. doi: http://doi.org/10.1586/era.13.54
Rouquette, I., Taranchon-Clermont, E., Gilhodes, J., Bluthgen, M.-V., Perallon, R., Chalabreysse, L. et. al. (2019). Immune biomarkers in thymic epithelial tumors: expression patterns, prognostic value and comparison of diagnostic tests for PD-L1. Biomarker Research, 7 (1). doi: http://doi.org/10.1186/s40364-019-0177-8
Wheler, J., Hong, D., Swisher, S. G., Falchook, G., Tsimberidou, A. M., Helgason, T. et. al. (2013). Thymoma Patients Treated in a Phase I Clinic at MD Anderson Cancer Center: Responses to mTOR Inhibitors and Molecular Analyses. Oncotarget, 4 (6), 890–898. doi: http://doi.org/10.18632/oncotarget.1015
Michels, G., Drebber, U., Pfister, R. (2012). Thymoma – an important differential diagnosis of mediastinal tumours. Acta Clinica Belgium, 67 (4), 304–305.
Girard, N., Ruffini, E., Marx, A., Faivre-Finn, C., Peters, S. (2015). Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 26, v40–v55. doi: http://doi.org/10.1093/annonc/mdv277
Klimova, E. M., Drozdova, L. A., Lavinskaya, E. V., Minukhin, D. V., Kudrevich, A. N. (2020). Advisability of thymectomy in young patients with thymus-independent myasthenia gravis in the presence of biomarkers specific for patients with thymoma. Kharkiv Surgical School, 3, 62–67. doi: http://doi.org/10.37699/2308-7005.3.2020.13
Boyko, V. V., Klimova, O. M., Lavinskaya, O. V., Drozdova, L. A., Minukhin, D. V., Yevtushenko, D. O. (2019). The Choice of Treatment in Various Ages Patients with Myasthenia Againstto Immuneresistance Parameters. International Journal of Education and Science, 2 (3). doi: http://doi.org/10.26697/ijes.2019.3.4
Toker, A., Sonett, J., Zielinski, M., Rea, F., Tomulescu, V., Detterbeck, F. C. (2011). Standard Terms, Definitions, and Policies for Minimally Invasive Resection of Thymoma. Journal of Thoracic Oncology, 6 (7), S1739–S1742. doi: http://doi.org/10.1097/jto.0b013e31821ea553
Yang, Y., Dong, J., Huang, Y. (2016). Thoracoscopic thymectomy versus open thymectomy for the treatment of thymoma: A meta-analysis. European Journal of Surgical Oncology (EJSO), 42 (11), 1720–1728. doi: http://doi.org/10.1016/j.ejso.2016.03.029
Barbolina, T. D., Bychkov, M. B., Allakhverdiev, A. K., Borisova, T. N., Vladimirova, L. Yu., Gerasimov, S. S. et. al. (2021). Prakticheskie rekomendatsii po lekarstvennomu lecheniyu opukholey vilochkovoy zhelezy (timomy i raka timusa). Malignant Tumours, 10 (3s2-1), 603–614. doi: http://doi.org/10.18027/2224-5057-2020-10-3s2-35
Maury, J.-M., Merveilleux du Vignaux, C., Drevet, G., Zarza, V., Chalabreysse, L., Maisse, C. et. al. (2019). Activation of the mTOR/ Akt pathway in thymic epithelial cells derived from thymomas. PLOS ONE, 14 (3), e0197655. doi: http://doi.org/10.1371/journal.pone.0197655
Pikin, О. V., Trakhtenberg, А. Kh., Kolbanov, K. I., Glushko, V. А., Kazakevich, V. I, Amiraliev, А. M. et. al. (2013). Circumferential inferior vena cava resection without prosthesis in patients with mediastinal tumor complicated by mediastinal compression syndrome. Oncosurgery, 2, 60–66.
Alexandrov, O. A., Ryabov, A. B., Pikin, O. V. (2017). Thymoma (review of the literature). Siberian Journal of Oncology, 16 (4), 76–83. doi: http://doi.org/10.21294/1814-4861-2017-16-4-76-83
Lee, G. D., Kim, H. R., Choi, S. H., Kim, Y. H., Kim, D. K., Park, S. I. (2016). Prosthetic graft interposition of the brachiocephalic veins or superior vena cava combined with resection of malignant tumours: graft patency and risk factors for graft occlusion. Journal of Thoracic Disease, 8 (1), 61–7. doi: http//doi.org/10.3978/j.issn.2072-1439.2016.01.07
Okereke, I. C., Kesler, K. A., Rieger, K. M., Birdas, T. J., Mi, D., Turrentine, M. W., Brown, J. W. (2010). Results of Superior Vena Cava Reconstruction With Externally Stented-Polytetrafluoroethylene Vascular Prostheses. The Annals of Thoracic Surgery, 90 (2), 383–387. doi: http://doi.org/10.1016/j.athoracsur.2010.04.004
Ruffini, E., Guerrera, F., Filosso, P. L., Bora, G., Nex, G., Gusmano, S. et. al. (2014). Extended transcervical thymectomy with partial upper sternotomy: results in non-thymomatous patients with myasthenia gravis. European Journal of Cardio-Thoracic Surgery, 48 (3), 448–454. doi: http://doi.org/10.1093/ejcts/ezu442
Odaka, M., Tsukamoto, Y., Shibasaki, T., Mori, S., Asano, H., Yamashita, M., Morikawa, T. (2017). Surgical and oncological outcomes of thoracoscopic thymectomy for thymoma. Journal of Visualized Surgery, 3, 54. doi: http://doi.org/10.21037/jovs.2017.03.18
Venuta, F., Rendina, E. A. (2012). Superior vena cava resection and reconstruction. European Journal of Cardio-Thoracic Surgery, 41 (5), 1177–1178. doi: http://doi.org/10.1093/ejcts/ezr266
Mayhew, D., Mendonca, V., Murthy, B. V. S. (2019). A review of ASA physical status – historical perspectives and modern developments. Anaesthesia, 74 (3), 373–379. doi: http://doi.org/10.1111/anae.14569
Copyright (c) 2021 Valeriy Boyko, Andriy Krasnoyaruzhskyi , Dmytro Minukhin , Dmytro Dubovyk , Kateryna Ponomarova , Anastasiya Sochnieva, Vasil Kritsak
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our journal abides by the Creative Commons CC BY copyright rights and permissions for open access journals.
Authors, who are published in this journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the journal under the terms of a Creative Commons CC BY, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form in which it has been published by the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.