Table_1_Case Report: Superior Vena Cava Resection and Reconstruction for Invasive Thyroid Cancer: Report of Three Cases and Literature Review.DOCX

Background: Thyroid cancer with massive invasion into the cervical and mediastinal great veins is extremely rare, and the surgical treatment is controversial, thus posing a great challenge for head and neck surgeons. Here, we report our successful experiences in reconstructing the superior vena cava (SVC) system to treat thyroid cancer with an extensive tumor thrombus growing intraluminally into the SVC.Case Presentation: From September 2019 to September 2020, three patients with superior vena cava syndrome(SVCS) caused by tumor thrombus invasion from thyroid cancer were continuously included in this series. After preoperative evaluation, radical resection and reconstruction of the SVC system with expanded polytetrafluoroethylene (EPTFE) grafts were performed. In addition, bypass support from the right internal jugular vein to the right femoral vein was routinely prepared intraoperatively to prevent a rise in central venous pressure (CVP). Postoperatively, SVC-related syndrome improved immediately after the operation. Imaging examination showed good function of the reconstructed venous system. The patients recovered well with no surgical complications and remain under continuous follow-up.Conclusions: Tumor growth into the SVC does not seem to be an absolute contraindication for surgery for thyroid carcinoma. Comprehensive treatment, including reconstruction of the SVC, is effective for relieving symptoms and preventing disease progression and is thus worth advocating. In addition, bypass support from the internal jugular vein to the femoral vein is easy to implement and can improve the safety of the operation.

背景：甲状腺癌大量侵犯颈部和纵隔大静脉极为罕见，其手术治疗存在争议，因此对头颈外科医生构成了巨大挑战。在此，我们报告了在治疗甲状腺癌时，对存在广泛肿瘤血栓并生长入上腔静脉（SVC）的患者进行SVC系统重建的成功经验。病例介绍：自2019年9月至2020年9月，连续纳入了3名因甲状腺癌肿瘤血栓侵犯导致上腔静脉综合征（SVCS）的患者。经过术前评估，对SVC系统进行了根治性切除和EPTFE（增强型聚四氟乙烯）移植物重建。此外，术中常规准备从右侧颈内静脉到右侧股静脉的旁路支持，以预防中心静脉压（CVP）升高。术后，SVC相关综合征在术后立即得到改善。影像学检查显示重建的静脉系统功能良好。患者恢复良好，无手术并发症，并持续接受随访。结论：肿瘤生长入SVC似乎并不是甲状腺癌手术的绝对禁忌症。包括SVC重建在内的综合治疗，对于缓解症状、防止疾病进展具有有效性，因此值得提倡。此外，从颈内静脉到股静脉的旁路支持易于实施，并能提高手术的安全性。