In the morning of April 21, in the operating room of Fudan University Shanghai Cancer Center, the team of Professor Haiquan Chen, director of thoracic surgery, and the team of Professor Yu Wang, director of head and neck surgery, were operating on the same table, working together to eradicate malignancies for a patient with "double primary tumors" in the neck and chest.

After a three-hour "relay" battle, the surgeons successfully performed the resection of the thymic tumor and mediastinal lymph nodes, completed the right radical thyroidectomy and cervical lymph nodes dissection, and disassembled the "time bomb".

Ms. Li, a 41-years-old lady, was the "protagonist" of this combined operation. Her neck and chest developed cancer at the same time, making it a "time bomb" for Ms. Li. The imaging report showed that Ms. Li had a mass in the anterior mediastinum from the chest to the neck, a mass in the right thyroid gland, and there were multiple lymphadenectasis in the neck, supraclavicular and mediastinum. In order to further diagnose the disease, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) and fine needle aspiration (FNA) of thyroid and neck masses were performed. The results showed that the mediastinal mass was squamous cell carcinoma, the thyroid mass and neck lymph nodes were papillary carcinoma. Subsequent laryngoscopy showed that Ms. Li's right vocal cord was paralyzed, indicating that the right recurrent laryngeal nerve had been invaded by the tumor. CT examination showed that mediastinal tumors might have invaded important structures such as the common carotid artery, brachiocephalic artery, and left brachiocephalic vein. The two tumors had become "ticking time bombs" that needed to be urgently disarmed.

Individualized treatment via 3D reconstruction of the tumor

The medical team carried out a three-dimensional reconstruction of the mediastinal tumor for Ms. Li. Through the three-dimensional images, the hierarchical structure of the tumors and adjacent vessels were displayed in more details. In the stereoscopic imaging, the thymic tumor was close to large blood vessels, as if surrounded by "high tension wires". A slight deviation during the operation might lead to serious bleeding. To this end, Professor Haiquan Chen's team and Professor Yu Wang's team formulated a strict cervical and thoracic joint surgery plan for Ms. Li, and fully prepared for surgical blood order schedules, and blood vessel replacement.

On April 21, the medical team began to operate on Ms. Li under strict protection. Intraoperative exploration revealed that Ms. Li's thymic tumor had invaded the left brachiocephalic vein, and was densely adhered to the common carotid artery, innominate artery, and trachea. Professor Haiquan Chen performed meticulous operations to cut off the invaded left innominate vein, successfully stripped the tumor from the surrounding vascular plexus, and completely removed the lymph nodes in the mediastinal area. Next, Professor Yu Wang performed a "relay" operation to separate the thymic tumor from the common carotid artery, trachea, esophagus, and prevertebral fascia. Then, the right thyroid and level VI metastatic lymph nodes were completely dissected and the lymph nodes in the neck were removed with minimized damage to the vagus nerve. With the cooperation of the two expert teams, it took only three hours to complete this difficult operation. Intraoperative frozen pathology showed that Ms. Li's anterior mediastinal thymus tumor was squamous cell carcinoma, the thyroid tumor was papillary carcinoma, and there was squamous cell carcinoma metastasis in cervical level IV lymph nodes. Ms. Li is recovering well up till the present moment.