A Systematic Review of Surgical Strategies for Managing Major Thoracic Vessels in Thoracic Oncology

Abstract

Background: The management of locally advanced thoracic malignancies, particularly those involving critical vascular structures, presents substantial surgical challenges. Surgery remains a cornerstone of treatment for these conditions, yet the involvement of the superior vena cava (SVC), pulmonary artery (PA), aorta, and thoracic outlet vessels complicates the process.

Methods: The literature search was performed from January 1990 to January 2025 in PubMed, Embase, and Cochrane according to PRISMA guidelines.

Results: Through the process of evidence acquisition, 78 types of research were identified: 27 focusing on SVC, and 25 focusing on PA, 15 focusing on the aorta, and 11 focusing on thoracic outlet vessels. The findings indicated that surgical management of the SVC and PA, although feasible, carries significant risks. The perioperative mortality for SVC surgeries ranged from 0 to 17%, with morbidity varying between 0 and 50%. For PA surgeries, the perioperative mortality ranged from 0 to 17.2% and morbidity ranged from 0 to 62%. Extended resections, including partial and total aortic resections, offered long-term survival rates of 25% to 40% for carefully selected patients.

Conclusion: Vascular reconstructions, such as subclavian artery resection followed by bypass, demonstrated a 70% success rate with a 35% 5-year survival rate. Vascular reconstructive techniques significantly extend surgical resection options, offering lung-sparing procedures for patients with bulky mediastinal masses and avoiding pneumonectomy in functionally challenging cases. Although advancements such as aortic endografting and cardiopulmonary bypass have improved outcomes, challenges such as hemorrhage, vascular injury, and neurologic deficits persist.