Surgical treatment strategy for thymic tumors invading the superior vena cava

Objective To explore surgical treatment strategies for thymic tumors invading the superior vena cava (SVC). Methods Fifty-seven patients were identified to have undergone surgery at our institution for thymic tumors invading the SVC from January 2016 to June 2021. The tumors were classified based on the involvement of the SVC as follows: type I, only the left or right innominate vein involved, so the patient underwent resection only without revascularization ( n = 25); type II, less than 30% of the SVC circumference involved, so the patient underwent direct resection followed by repair of the SVC defect ( n = 2); and type III, more than 30% of the SVC circumference involved, so the patient underwent single conduit reconstruction between the innominate vein and right atrial appendage first followed by extended resection of the tumor and the invaded portion of the SVC ( n = 30). Results Complete resection was achieved in all patients. Most patients (54/57) had high-risk thymoma or thymic carcinoma. No serious complications occurred in patients with type I or type II tumors. Three of the 30 patients with type III tumors died, two required repeat surgery, one experienced a myasthenia gravis crisis, and one developed a surgical site infection. The median follow-up duration was 22 months. The 5-year progression-free survival and overall survival rates were 59.6% and 81.2%, respectively. Conclusion This typing method can be used to guide selection of the surgical strategy for a thymic tumor involving the SVC. A strategy of single-vessel reconstruction before extensive resection is appropriate for patients with a type III tumor.