A hybrid approach via video-assisted thoracoscopic surgery and limited sternal incision for resection of invasive thymoma with superior vena cava prosthetic replacement: a case report

When an invasive thymoma involves major vessels such as the superior vena cava (SVC), conventional management requires median sternotomy with en bloc resection and vascular reconstruction, which carries substantial surgical trauma and delayed recovery. This report presents a case of invasive thymoma invading the SVC and left innominate vein treated using a hybrid approach combining video-assisted thoracoscopic surgery (VATS) with a limited sternal incision, in which the technical highlight was a Y-shaped reconstruction of the SVC and left innominate vein. A 39-year-old woman presented with an incidentally discovered anterior mediastinal mass. Contrast-enhanced CT showed an invasive thymoma(3.7 cm×3.0 cm×5.6 cm) invading the SVC and left innominate vein confluence. After multidisciplinary evaluation, preoperative biopsy was deemed too hazardous owing to the tumor’s intimate proximity to the great vessels, and upfront surgery was recommended. Thoracoscopic exploration via a 3 cm subxiphoid incision confirmed resectability, followed by partial upper sternotomy (≈ 12 cm). Under temporary venous shunting and clamping of the SVC and left innominate vein, the tumor and invaded vessels were resected en bloc. The SVC was replaced with an 18 F PTFE (Goretex) graft, and the left innominate vein was reconstructed with a tubularized bovine pericardial conduit anastomosed end-to-side to the SVC graft, creating a Y-shaped reconstruction. Operative time was 315 min with 800mL blood loss. Recovery was uneventful. Pathology confirmed WHO type B2 thymoma, Masaoka–Koga stage III, and adjuvant radiotherapy was given. During follow-up, the prosthetic graft remained patent and no recurrence was detected. A hybrid VATS-assisted approach with limited sternal incision enables reliable vascular reconstruction while reducing invasiveness, representing a feasible and safe option for invasive thymomas involving the SVC. Multidisciplinary evaluation, appropriate patient selection and proficiency in both minimally invasive techniques and open vascular reconstruction are essential to achieve R0 resection and favorable outcomes.