Outcomes and Safety Analysis in Superior Vena Cava Resection for Extended Thymic Epithelial Tumors

Abstract Background In stage III–IVa thymic epithelial tumors (TETs), infiltration of superior vena cava (SVC) is not rare. The extent of SVC resection depends on the width of the area of neoplastic invasion. Our paper aims to evaluate the safety and long-term outcomes of extended thymectomy for TETs with SVC resection compared with advanced-stage TETs patients without SVC resection. Methods Retrospective review of the experience on patients who underwent extended thymectomy for TETs in the last twenty years, according to STROBE methodology. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan–Meier method. A backward stepwise Cox regression multivariate analysis was performed to determine factors associated with long-term outcomes. Results 78 patients underwent surgery for advanced-stage TETs (Masaoka-Koga stages III–IVa) from January 1998 to April 2019. 14 (17.9%) underwent thymectomy with resection of SVC. Presence of a thymic carcinoma (HR=2.26; 95% CI=1.82–6.18; p=0.038) and the SVC resection (HR=1.89; 95% CI=1.11–3.96; p=0.041) were adverse prognostic factors at multivariate analysis. The median OS and the PFS of all SVC resected patients were 50 (range: 5–207) and 31 months (range: 5–151), respectively. There was no significant difference in OS (p=0.28) and PFS (p=0.32) between SVC resected and not resected patients. Conclusions SVC resection is a safe and effective procedure to restore the venous system continuity and does not seem to affect survival and disease recurrence. This surgical approach allows radical resection of locally advanced TETs, even after neoadjuvant chemotherapy.