Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Superior Vena Cava Resection and Reconstruction in Thoracic Malignancy

상대정맥을 침범한 흉부종양의 수술적 치료

  • Han, Kook-Nam (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kang, Chang-Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Young-Tae (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Jheon, Sang-Hoon (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Sung, Sook-Whan (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital) ;
  • Kim, Joo-Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine)
  • 한국남 (서울대학교 의과대학 서울대학교병원 흉부외과학교실) ;
  • 강창현 (서울대학교 의과대학 서울대학교병원 흉부외과학교실) ;
  • 김영태 (서울대학교 의과대학 서울대학교병원 흉부외과학교실) ;
  • 전상훈 (분당서울대학교병원 흉부외과) ;
  • 성숙환 (분당서울대학교병원 흉부외과) ;
  • 김주현 (서울대학교 의과대학 서울대학교병원 흉부외과학교실)
  • Received : 2009.10.24
  • Accepted : 2010.01.12
  • Published : 2010.06.05
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Abstract

Background: The benefit of superior vena cava (SVC) resection in thoracic malignancies remains controversial. We analyzed the results of extended resection in patients with thoracic malignancy involving the SVC. Material and Method: From March 2000 to March 2009, we performed surgical resection and reconstruction in 18 thoracic malignancies involving the SVC. Ten male and 8 female enrolled and their mean age was 56 years. Result: SVC reconstruction was performed in 9 patients with polytetrafluoroethylene (PTFE) graft. Primary closure was possible in 6 patients by partially clamping the SVC. Patch angioplasty was performed in 3 patients with PTFE or autologous pericardial patch. Three-year survival was 58.0% and median survival time was 24.5 months. Disease specific survival and recurrence free survival were not significantly different between lung cancer and mediastinal malignancy. Obstruction of graft was detected in 4 patients during follow-up; SVC graft obstruction in 1 patient, and accessory graft between the innominate vein and right atrium in 3 patients. Conclusion: Extended resection of thoracic malignancies involving the SVC was a feasible method in selected patients. Although the morbidity rate was relatively high, mid-term survival was acceptable when complete resection was possible.

배경: 상대정맥을 침범한 흉부 종양의 수술은 종양의 병기가 진행된 상태로 인하여 수술적 치료에 대한 보고가 흔하지 않았다. 본 연구에서는 상대정맥 침범 종양의 수술적 치료 결과에 대한 후향적 고찰을 시행하고자 하였다. 대상 및 방법: 2000년 5월부터 2009년 5월까지 상대정맥을 침범한 흉부 종양으로 본원에서 상대정맥의 부분 혹은 완전 절제술을 받은 환자 18명을 대상으로 하였고 성별은 남자 10명, 여자 8명, 수술 당시 평균 연령은 56.6세였다. 결과: 수술 방법은 Polytetrafluoroethylene (PTFE)도관을 이용한 재건술이 9예, 일차봉합이 6예, 첩포 성형술이 3예에서 시행되었다. 재원기간 중앙값은 14.5일(6~61), 추적 관찰기간 중앙값은 23개월(1~88)이었다. 전체 악성 종양 환자의 3년 생존율은 58.0%, 생존기간의 중앙값은 24.5개월이었다. 폐암, 종격동 종양에 따른 생존율과 무병율의 차이는 뚜렷하지 않았다. 상대정맥 재건술을 시행한 환자 중 1명에서 주도관인 상대정맥 도관의 폐쇄가 발생하였고 3명에서 부도관인 무명정맥 도관의 폐쇄가 발생하였다. 결론: 상대정맥을 침범한 폐암과 종격동 종양은 수술적 절제로 효과적으로 치료될 수 있었으며, 여러 가지 수술 후 합병증에도 불구하고 좋은 장기 생존율을 보여 이러한 환자 군에서 적극적인 수술적 치료가 고려되어야 한다고 판단된다.

Keywords

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