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 reported that he had previously only experienced intermittent shortness of breath but was otherwise functioning normally. However, a CT scan revealed a massive tumor, nearly 11 cm in size, extending from the neck down to the chest, severely compressing the trachea, invading the entire thyroid gland, and adhering closely to major blood vessels. The widest part of the narrowed trachea was only about 4.35 mm. This is a severe case of tracheal stenosis, making airway management very difficult. Imaging studies also showed multiple scattered lesions in the lungs, raising suspicions of widespread cancer.

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

Associate Professor, Doctor Vu Huu Vinh, Head of the Thoracic Surgery Department at Nam Saigon International General Hospital, stated: “This is an extremely complex case. The tumor surrounded and invaded, constricting the trachea, causing severe narrowing, spreading to the anterior-superior mediastinum, invading branches of the supraorbital artery, brachiocephalic vein, and superior vena cava, threatening the patient's life. Therefore, surgery needed to be performed urgently to remove the tumor and reconstruct the airway for the patient.”

Before a life-or-death surgery, a hospital-wide consultation takes place to ensure maximum safety for the patient. (Photo: Provided by the hospital)

Faced with a rare and challenging situation, with the tumor located in a critical position within the chest cavity, the treatment team was forced to act immediately. An emergency hospital-wide consultation was held to comprehensively assess treatment options and develop a contingency plan for all possible scenarios.

Dr. Nguyen Truong Khuong, Director of Professional Services at Nam Saigon International General Hospital, shared: “We thoroughly explained the complexity and risks of the surgery to the patient and their family. Given the patient and their family's fervent desire for surgery, we decided to meticulously prepare every step, anticipating all possible scenarios. Everyone put in their utmost effort to ensure a successful surgery and save the patient.”

The "deadly" tumor has just been removed from the patient's body. Photo: Provided by the hospital.

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

Immediately, the doctors proceeded to remove the entire mediastinal tumor and thyroid gland to preserve the major blood vessels. Hemostasis was carefully controlled before closing the sternum with steel sutures. The entire surgery lasted 3 hours, but the amount of blood lost was only about 450ml – an astonishing figure for such a complex operation.

Commenting further on the success of this surgery, Dr. Vu Thi Thu Huong, Deputy Director of Professional Affairs and Head of the Anesthesia and Resuscitation Department at Nam Saigon International General Hospital, said: “We anticipated the risks and prepared many contingency plans. A favorable factor was that the remaining tracheal parenchyma was soft, allowing us to apply the technique of gradually increasing the size of the endotracheal tube – starting with a very small tube of about 4.5 mm and then gradually expanding it to 7 mm. Thanks to this, the team successfully controlled the airway, ensuring the patient's safety throughout the surgery.”

The patient's lungs are more open after surgery (Photo: Provided by the hospital)

After surgery, the patient was transferred to the Thoracic Surgery department for monitoring without requiring further treatment in the Intensive Care Unit. Just a few days later, the patient was able to breathe deeply and comfortably, and resume near-normal eating and daily activities.

Considered a complex and highly challenging case, the surgery required not only advanced professional skills but also seamless coordination between multiple specialties and state-of-the-art equipment.

This success not only saved the patient's life but also reaffirmed the professional competence, ability to handle rare and complex cases, and commitment of "All for the patient" of Nam Saigon 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