Removing a giant tumor that “enveloped” the trachea, freeing the airway for a 75-year-old man

With just a few days of delay, a nearly 11cm malignant mediastinal tumor could have completely blocked the airway. Mr. KL (75 years old, Cambodia) narrowly regained his life thanks to a successful partial sternotomy at the South Saigon International General Hospital.

The patient said that before that, he only felt short of breath but still went about his daily activities normally. However, the CT scan results showed a giant tumor measuring nearly 11cm, spreading from the neck to the chest, severely compressing the trachea, invading the entire thyroid gland and sticking to the large blood vessels. The widest part of the narrowed trachea was only about 4.35mm. This is a severe tracheal stenosis and it is very difficult to control the airway. The imaging results also showed many scattered lesions in the lungs, raising the suspicion that the cancer had spread.

Treatment becomes even more difficult when the patient has multiple underlying medical conditions: three-vessel coronary artery disease (with stent placement), hypothyroidism, and hypertension.

Associate Professor, Doctor, Doctor Vu Huu Vinh, Head of the Department of Thoracic Surgery, Nam Sai Gon International General Hospital, said: “This is an extremely complicated case. The tumor surrounded and invaded, squeezing the trachea causing severe narrowing, spreading to the anterior-superior mediastinum, invading the branches of the superior arch artery, innominate vein and superior vena cava, threatening the patient's life. Therefore, surgery needs to be performed urgently to remove the tumor and reconstruct the patient's airway.”

Before the life-and-death surgery, a hospital-wide consultation took place to ensure maximum safety for the patient. Photo: BVCC

Faced with a rare and challenging situation, when the tumor was located in a “dangerous” position in the chest, the treatment team was forced to act immediately. An emergency hospital-wide consultation was held to comprehensively evaluate the treatment plan and develop a response plan for all possible situations.

Master-Doctor-CKII Nguyen Truong Khuong, Professional Director at Nam Sai Gon International General Hospital shared: “We have thoroughly explained the complexity and risks of surgery to the patient and his family. Given the patient and his family’s earnest desire to have surgery, we decided to prepare every step carefully and thoughtfully, and come up with all contingency scenarios. We are all doing our best to successfully perform the surgery to save the patient.”

The “death” tumor has just been removed from the patient’s body. Photo: BVCC

During surgery, a portion of the tumor tissue was removed with an ultrasonic scalpel and sent for biopsy. The results showed that it was malignant cancer.

Immediately, the doctors proceeded to remove the entire mediastinal tumor and thyroid gland to preserve the major blood vessels. The hemostasis process was strictly controlled before closing the sternum with steel sutures. The entire surgery lasted 3 hours, but the amount of blood loss was only about 450ml - this is an amazing number for such a complex surgery.

Commenting further on the success factors of this surgery, Dr. Vu Thi Thu Huong, Deputy Director of Professional Affairs, Head of the Department of Anesthesia and Resuscitation at Nam Sai Gon International General Hospital, said: “We anticipated the risks and prepared many backup plans. The advantage is that the remaining tracheal parenchyma is soft, allowing us to apply the technique of placing the endotracheal tube by gradually increasing the size - from a very small tube of about 4.5 mm and then gradually expanding it to 7 mm. Thanks to that, the team successfully controlled the airway, ensuring the patient's life and safety throughout the surgery.”

The patient's lungs are clearer after surgery (Photo: BVCC)

After surgery, the patient was transferred to the Thoracic Surgery Department for monitoring without requiring further treatment in the Intensive Care Unit. And just a few days later, the patient was able to breathe deeply and easily, eat and drink, and live almost normally.

Considered a complex and challenging case, the surgery not only requires high professional skills but also requires smooth coordination between many specialties and a modern equipment system.

This success not only saves the patient's life, but also once again affirms the professional capacity, ability to handle rare and complicated cases and the commitment "All for the patient" of Nam Sai Gon International General Hospital.

Source: https://www.sggp.org.vn/cat-bo-khoi-u-khong-lo-om-tron-khi-quan-giai-phong-duong-tho-cho-cu-ong-75-tuoi-post809185.html