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After finding out about this disease, Aunt Ding's (pseudonym) family once fell into despair.
Tumors at the cervical-thoracic junction are rare. Because of its special location, it was once regarded as a surgical off-limit. Even now, it is still a difficult and high-risk operation.
Due to chest discomfort
Special large tumors were detected
Aunt Ding is a patient with multiple schwannomas who has undergone two tumor resection surgeries in the neck and abdomen in the past 20 years.
At the beginning of this year, due to chest discomfort, a chest CT was done at the local hospital and it was found that her left chest cavity continued until her neck was occupied by a tumor. Due to the special location of the tumor, the local hospital recommends going to a higher-level hospital for medical treatment.
Aunt Ding's whole family was very nervous, asked around, and was introduced to the outpatient clinic of Dr. He Zhengfu, chief physician of the Department of Thoracic Surgery of Run Run Shaw Hospital.
Director He carefully read the image data brought by Aunt Ding and found that the tumor was relatively large and the growth location span was also very large, from the neck to the chest.
Due to the compression of the tumor, Aunt Ding's left subclavian artery is narrowed, and the diameter is only about half of that of a normal person.
If the tumor continues to grow, there may be compression displacement of important blood vessels, nerves, esophagus and trachea, resulting in serious complications and increasing the risk of surgery, and the doctor immediately arranged for Aunt Ding to be hospitalized.
Further examination after admission found that the "root" of the tumor was located in the 6th cervical vertebra, and this area could also see the "traces" of surgery 20 years ago, considering that the schwannoma had recurred, and several large and small tumors were found on multiple vertebral bodies.
Given that the tumor is located at the cervical-thoracic junction, spanning multiple disciplines such as the neck, chest, spine, and the small operating space of this position, the visual field exposure is poor, and it is easy to cause damage to the surrounding tissues during the operation, causing complications such as postoperative hoarseness, chyle, honer sign, and even paraplegia, the operation must not be easy.
Multidisciplinary "relay" surgery
Cut the tumor as fist-sized
Chief Physician He Zhengfu, Chief Physician Li Xinwei of The Department of Neurosurgery, Deputy Chief Physician Zhang Deguang of the Department of Head and Neck Surgery, and Chief Physician Zheng Weiliang of the Department of Radiology formed the MDT team to discuss this rare case in detail and formulate a detailed surgical plan.
On January 10, 2022, the surgical "relay" officially began.
First of all, in the first stage, the chief physician of the Neurosurgery Department, Li Xinwei, "cut off the root" of the tumor, that is, the tumor in the vertebral body was removed to reduce the risk of postoperative paraplegia; the doctor also cleared the tumor of other segments of the vertebral body, and the postoperative pathology was also confirmed as a schwannoma. Then Aunt Ding was discharged from the hospital and went home for a year of peace, recuperating and preparing for the second stage of cervical and thoracic surgery.
After the end of the year, Aunt Ding was admitted to the thoracic surgery ward again, and according to the plan, the trophoblast artery emitted by the left subclavian artery was successfully embolized by the chief physician of the Radiology Department, Zheng Weiliang, to reduce the risk of heavy bleeding during tumor resection.
Finally, the team of chief physicians He Zhengfu (chief physician He Zhengfu, deputy chief physician Zhang Hu, attending physician Wang Yunzhen) and deputy chief physician Zhang Deguang of head and neck surgery worked together to treat the tumors in the cervical and thoracic parts.
Because of the special location and fewer cases, there is no unified conclusion at home and abroad on the way to enter this operation.
According to the characteristics of Aunt Ding's tumor, the doctor decided to use an inverted L-shaped incision based on the principle of full tumor exposure and minimizing trauma.
Invert the L incision
Incision after suturing
On February 24, 2022, under the escort of multiple disciplines, the operation began.
Deputy Chief Physician Zhang Deguang began to free the tumor in the neck and loosen it completely from the surrounding tissues; then Chief Physician He Zhengfu freed the tumor of the chest cavity and finally removed the fist-sized tumor completely.
The procedure went smoothly, with less bleeding and no damage to the important tissue structures around it.
On the first day after the operation, Aunt Ding spoke normally and was able to get out of bed normally, which made the team breathe a sigh of relief.
However, on the third day, the drainage of the drainage tube in the neck began to increase, the color was cool, and Director He considered that it was chylomeric fluid, which may be caused by the damage of the small branch of the chest catheter, so Aunt Ding began to eat without fat.
However, in the next few days, the drainage fluid continued to increase, so the measures of fasting and continuous negative pressure attraction were taken. Finally, the drainage was gradually reduced to 5 ml per day, and the fat-free diet was continued to be observed for two days, and the drainage did not increase, so the drainage tube was removed and discharged home.
Related science
Tumor at the cervical-thoracic junction
A tumor at the cervicothoracic junction is a tumor at the root of the neck that grows downward or a tumor of the mediastinum of the chest that extends upwards beyond the tumor that is the anatomical dividing line of the neck and chest, that is, a tumor across the collarbone or sternum.
Tumors in this location are benign or malignant.
Benign tumor
Generally, there are benign neurogenic tumors, benign thyroid tumors, hemangiomas, lipomas, cystic lymphangiomas, mediastinal cysts, etc.;
malignancy
Generally, there are malignant neurogenic tumors, pancoast tumors, lymphoma, thyroid cancer, sarcoma, upper esophageal cancer, malignant thymoma, metastatic lymph nodes, etc.
The cervical-thoracic junction is surrounded by bony structures such as the sternum, collarbone and vertebral body to form a narrow space, which has more important blood vessels, nerves, esophagus and trachea through, these important tissue structures are often squeezed by tumors or earlier invasion, resulting in difficulty in surgical exposure, which was regarded as a surgical exclusion zone for a long time in the past.
However, even if the tumor at the cervical-thoracic junction is malignant, it is mainly manifested by local progression and recurrence tendency, and the time of metastasis is relatively late, and complete tumor resection can bring great hope for cure.
The Department of Thoracic Surgery of Shaw Hospital carries out surgery on tumors at the junction of the complex neck and chest under the multidisciplinary cooperation model, hoping to bring more hope to patients.
Source: Run Run Shaw Hospital
Author: Department of Thoracic Surgery Wang Yunzhen
Original works, reprinted please indicate the source and source
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