43. Reconstruction Followed by Extended Resection for a Thymoma Invading the Superior Vena Cava

Objective: To investigate the surgical treatment of thymoma invading the superior vena cava.
Case Video Summary: Median sternotomy was performed to access the chest cavity, separate the tissue around the tumor, open the pericardium and fully expose the right atrium. The left innominate vein was separated and divided away from the tumor. Its proximal end was ligated, and the distal end was clamped with atrial appendage forceps. During the operation, heparin was given for anticoagulation (1 mg/kg), and the artificial blood vessel (with a diameter based on the diameter of the left innominate vein) was anastomosed to the distal end of the left innominate vein. The right atrial appendage was clamped by the atrial appendage forceps, and part of the right atrial appendage was removed. The orifice of the atrial appendage was anastomosed to the other end of the artificial blood vessel. The superior vena cava was separated and divided above the right atrium, and the right innominate vein was separated and divided above the tumor. The arch of the azygos vein was separated and divided. The specimen was separated and completely removed.
Conclusions: Extended resection of thymoma combined with artificial bypass between innominate vein and right atrial appendage can be used to treat patients with thymoma invading the superior vena cava.

Jia-Hao Jiang (1), Shuai Wang (2), Yi Zhang (2), jian-yong ding (2), (1) Zhongshan Hospital of Fudan University, Shanghai, China, (2) Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China

Erino Angelo Rendina

Invited Discussant

Erino A. Rendina is Professor and Chairman of Thoracic Surgery at Sapienza, University of Rome, and he is Deputy Dean of the Medical School. He was the 2009 President od the European Association for Cardiothoracic Surgery. He is Deputy Editor of The Annals of Thoracic Surgery, and has published  391  papers in peer-reviewed journals  with an h-index of 43  (scopus). Professor Rendina has been  Visiting Professor in many mayor universities across the world. His Division performs approximately 1.400 thoracic surgical operations per year including complex oncological procedures on the bronchi, pulmonary artery, carina, superior vena cava, aorta and heart. Tracheal reconstruction is also performed routinely with a peak of 60 procedures in 2020, including 4 Tracheal replacement by aortic allograft.

Jia-Hao Jiang

Case Video Presenter

Dr. Jiang is an attending doctor at department of thoracic surgery, Zhongshan Hospital of Fudan University, Shanghai, China​. He earned his M.D. degree at Fudan University Shanghai Medical College, trained and completed his thoracic surgery training at Zhongshan Hospital of Fudan University. He practices all aspects of thoracic surgery but has special interest and experience in lung cancer and mediastinal diseases. He looks towards minimally invasive approaches including VATS lobectomy and subxiphoid thymectomy. His work has been published in important journals such as The Annals of Thoracic Surgery and Nature Communications.

Specialties: General Thoracic, Thoracic, Mediastinum, Thymus, Anatomy and Conditions, Mediastinum, Treatment/Procedure/Operation/Surgery, Thymus, Thymoma