Left transmanubrial approach for reconstruction of superior vena cava during excision of thymic carcinoma: A case report

A 49-year-old female was referred to our hospital presenting with fever, cough, sputum, and left arm edema. Computed tomography revealed a 7.5-cm mediastinal tumor, an obstructed left brachiocephalic vein, a constricted superior vena cava (SVC), the upper lobe of the right lung infiltrated by the tumor, and pericardial effusion. The patient underwent an ultrasound-guided needle biopsy of the tumor, and then she was diagnosed with thymic squamous cell carcinoma (cT3 N0 M1a, cStage IVA). Concurrent chemoradiotherapy led to a marked tumor volume reduction and the disappearance of pericardial effusion (ycT3 N0 M0, ycStage IIIA). Conversion surgery was performed to excise the thymus, pericardium, SVC, upper lobe of the right lung, and right phrenic nerve, and reconstruct SVC. The planed incision was a median sternotomy and an intercostal thoracotomy involving the right thorax. However, an additional transmanubrial approach to the left thorax was needed to reconstruct SVC because the left brachiocephalic vein was obstructed to the point at the venous angle. Curative resection of the tumor was confirmed microscopically. No recurrence was noted for 14 months after the surgery.