Superior vena cava obstruction: diagnosis, management and outcome

Abstract

Objective: To document our experience with superior vena cava obstruction in a black African population.

Design: A retrospective study of clinical data collected from cancer registry, patients case noted, cardiothoracic surgical unit's and operating records between June 1975 and May 1999.

Setting: University College Hospital, Ibadan, Nigeria which hosts a major cancer centre in the West African sub-region and also serves community clinics.

Patients: All patients with superior vena cava (SVC) obstruction referred for evaluation and treatment.

Main outcome measures: Patients who had clinical features related to SVC obstruction and full investigation including tissue diagnosis were collated. Methods of treatment of acute episodes, definitive treatment and outcome of SVC obstruction were studied.

Results: One hundred and twenty nine consecutive patients with SVC obstruction were treated. There were 100 males and 29 females. Mean age was 36 +/- 15 years. The annual incidence increased from 2.3 patients per year during the first 12 years to 8.4 patients per year during the second 12 years. The most common symptoms were swelling of face, arms and chest-wall (87.6%) with associated venous congestion over these areas. Majority of the patients (73.8%) presented within 1 to 12 months of onsets of symptoms. Patients with benign diseases had longer duration of symptoms before presentation (mean 3 months) than those with malignant disease (mean 6 months). Majority of the patients (82.2%) had malignancy as the underlying cause of the SVC obstruction and 47.2% of the malignancy was bronchogenic carcinoma. Symptomatic relief and outcome was best in benign disease (7 out of 8 patients, 87.5%). Lymphomas had better outcome than bronchogenic carcinoma among the patients with malignant diseases.

Conclusion: Patients with SVC obstruction should be carefully evaluated before treatment. This will enhance application of specific therapy.