Extracorporeal membrane oxygenation (ECMO) assisted huge mediastinal tumor resection combined with superior vena cava replacement: A case report and literature review
Restricted accessCase reportFirst published online April, 2025
Extracorporeal membrane oxygenation (ECMO) assisted huge mediastinal tumor resection combined with superior vena cava replacement: A case report and literature review
As to huge solid mediastinal tumor which direct compression or invasion of the superior/inferior vena cava (SVC/IVC), surgical resection remains the main lifesaving treatment. However, it would present formidable anesthetic challenges due to the extremely high risks of cardiorespiratory compromise, drastic hemodynamic fluctuations and death at all perioperative stages. Here, we report a case of huge anterior mediastinal tumor resection combined with SVC replacement under the assistance of venoarterial extracorporeal membrane oxygenation (VA ECMO), and stable hemodynamics were maintained as well as high internal jugular vein pressure being avoided during the operation procedure. He was weaned off ECMO successfully just after surgery and eventually discharged. No signs of postoperatively neurological complications occurred. Therefore, the use of ECMO assistance in huge mediastinal tumor resection combined with SVC replacement is feasible and safe, which may provide the possibility of surgical treatment for such patients and improve outcomes.
VenutaFRendinaEA. Superior vena cava resection and reconstruction. Eur J Cardio Thorac Surg2012; 41(5): 1177–1178.
2.
BechardPLetourneauLLacasseY, et al.Perioperative cardiorespiratory complications in adults with mediastinal mass: incidence and risk factors. Anesthesiology2004; 100(4): 826–834.
3.
ScorsettiMLeoFTramaA, et al.Thymoma and thymic carcinomas. Crit Rev Oncol Hematol2016; 99: 332–350.
4.
LiWWvan BovenWJAnnemaJT, et al.Management of large mediastinal masses: surgical and anesthesiological considerations. J Thorac Dis2016; 8(3): E175–E184.
5.
TanJCLinPSHeLXEvidence in Cardiovascular AnesthesiaEICA Group, et al.Anesthetic management of patients undergoing mediastinal mass operation. Front Surg2022; 9: 1033349.
6.
HackHAWrightNBWynnRF. The anaesthetic management of children with anterior mediastinal masses. Anaesthesia2008; 63(8): 837–846.
7.
HondaMYukiATakahiroH, et al.Predictive risk score of respiratory complications in children with mediastinal tumors: a case-control study. Cancer Med2023; 12(2): 1167–1176.
8.
GhignaMRThomasDEMontprevilleV. Mediastinal tumours and pseudo-tumours: a comprehensive review with emphasis on multidisciplinary approach. Eur Respir Rev2021; 30(162): 200309.
9.
Dell’AmoreACampisiABertolacciniL, et al.A multicenter retrospective cohort study on superior vena cava resection in non-small-cell lung cancer surgery. Cancers2022; 14(24): 6138.
10.
PicquetJBlinVDussaussoyC, et al.Surgical reconstruction of the superior vena cava system: indications and results. Surgery2009; 145(1): 93–99.
11.
SpaggiariLLeoFVeronesiG, et al.Superior vena cava resection for lung and mediastinal malignancies: a single-center experience with 70 cases. Ann Thorac Surg2007; 83(1): 223–229.
12.
MauriziGPoggiCD’AndrilliA, et al.Superior vena cava replacement for thymic malignancies. Ann Thorac Surg2019; 107(2): 386–392.
13.
DaiWDongJZhangH, et al.Superior vena cava replacement combined with venovenous shunt for lung cancer and thymoma: a case series. J Thorac Dis2018; 10(1): 363–370.
14.
MatsumotoKYamasakiNTsuchiyaT, et al.Temporary bypass for superior vena cava reconstruction with anthron bypass tube(TM). J Thorac Dis2017; 9(7): E614–E618.
15.
ElbaserIIAEl DerieAAEA. Does extrathoracic jugulo-femoral venous shunt avoid cardiopulmonary bypass in glenn bi-directional shunt procedure?Turk J Anaesthesiol Reanim2020; 48(1): 44–49.
16.
DartevellePMacchiariniPChapelierA. Technique of superior vena cava resection and reconstruction. Chest Surg Clin1995; 5(2): 345–358.
17.
de GiacomoTPatellaMMazzesiG, et al.Successful resection of thymoma directly invading the right atrium under cardiopulmonary bypass. Eur J Cardio Thorac Surg2015; 48(2): 332–333.
18.
RiedMNeuRSchalkeB, et al.Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support. J Cardiothorac Surg2015; 10: 137.
19.
RinieriPPeillonCBessouJP, et al.National review of use of extracorporeal membrane oxygenation as respiratory support in thoracic surgery excluding lung transplantation. Eur J Cardio Thorac Surg2015; 47(1): 87–94.
20.
LindstromSJPellegrinoVAButtWW. Extracorporeal membrane oxygenation. Med J Aust2009; 191(3): 178–182.
21.
NokesBTVaszarLJahanyarJ, et al.VV-ECMO-assisted high-risk endobronchial stenting as rescue for asphyxiating mediastinal mass. J Bronchology Interv Pulmonol2018; 25(2): 144–147.
22.
FeltenMLMichel-CherquiMPuyoP, et al.Extracorporeal membrane oxygenation use for mediastinal tumor resection. Ann Thorac Surg2010; 89(3): 1012.
23.
Gonzalez-FajardoJAGarcia-YusteMFlorezS, et al.Hemodynamic and cerebral repercussions arising from surgical interruption of the superior vena cava. Experimental model. J Thorac Cardiovasc Surg1994; 107(4): 1044–1049.
24.
LamJCChuiCHJacobsenAS, et al.When is a mediastinal mass critical in a child? An analysis of 29 patients. Pediatr Surg Int2004; 20(3): 180–184.
25.
RamanathanKLeowLMithiranH. ECMO and adult mediastinal masses. Indian J Thorac Cardiovasc Surg2021; 37(Suppl 2): 338–343.
26.
MillarJEFanningJPMcdonaldCI, et al.The inflammatory response to extracorporeal membrane oxygenation (ECMO): a review of the pathophysiology. Crit Care2016; 20(1): 387.
27.
FangZANavaeiAHHenschL, et al.Hemostatic management of extracorporeal circuits including cardiopulmonary bypass and extracorporeal membrane oxygenation. Semin Thromb Hemost2020; 46(1): 62–72.
28.
YuJBWilsonLDDetterbeckFC. Superior vena cava syndrome--a proposed classification system and algorithm for management. J Thorac Oncol2008; 3(8): 811–814.
29.
ChaudharyKGuptaAWadhawanS, et al.Anesthetic management of superior vena cava syndrome due to anterior mediastinal mass. J Anaesthesiol Clin Pharmacol2012; 28(2): 242–246.
30.
FrawleyGLowJBrownTC. Anaesthesia for an anterior mediastinal mass with ketamine and midazolam infusion. Anaesth Intensive Care1995; 23(5): 610–612.
31.
AbdelmalakBMarcanthonyNAbdelmalakJ, et al.Dexmedetomidine for anesthetic management of anterior mediastinal mass. J Anesth2010; 24(4): 607–610.
32.
FernandesHDSXimenesJLSNunesDI, et al.Failure of reversion of neuromuscular block with sugammadex in patient with myasthenia gravis: case report and brief review of literature. BMC Anesthesiol2019; 19(1): 160.
33.
MahmoodAMushambiMPorterR, et al.Regional anaesthesia with extracorporeal membrane oxygenation backup for caesarean section in a parturient with neck and mediastinal masses. Int J Obstet Anesth2018; 35: 99–103.
