Summary
A woman in her 60s with a large sarcoma of the chest wall was admitted to the Department of Thoracic Surgery, Kyoto University Hospital, after being informed at another institution that the tumor was unresectable. After confirming the location of the growth -- surrounded by the lungs, heart, esophagus, and liver, while being wrapped around the inferior vena cava and extending close to a hepatic vein -- the Kyoto University surgeon in charge assembled a special team of doctors spanning five departments -- Cardiovascular Surgery, Hepatobiliary Pancreatic Surgery and Transplantation, Gastrointestinal Surgery, and Anesthesia, as well as Thoracic Surgery -- to discuss strategies for removing the bulky tumor.
The operation, which took place late July at the University Hospital, lasted 11 hours. Specialists from the five Departments worked together to remove the inferior vena cava, parts of the right lung, pericardial sac, and diaphragm, along with the whole of the tumor itself. The procedures performed included placing the patient on a heart-lung machine, blocking blood flow to the liver for 20 minutes, and replacing the inferior vena cava with a synthetic blood vessel.
The patient made a smooth recovery, and was discharged from the hospital on 20 August.
Rare condition addressed through unusual cooperation
It is extremely rare for a chest-wall sarcoma of such a large size to grow near the inferior vena cava. The leiomyosarcoma -- as this type of tumor is known in pathology -- was actually the largest ever to have been found in the chest wall. Furthermore, it was surrounded by the lungs, heart, esophagus, diaphragm, and liver, making it unresectable by surgeons from any single department. The operation performed at the University Hospital would not have been possible without the doctors from the five Departments -- Thoracic Surgery, Cardiovascular Surgery, Hepatobiliary Pancreatic Surgery and Transplantation, Gastrointestinal Surgery, and Anesthesia -- working together as a team. While surgery involving multiple departments is relatively common, five of them working together is remarkable.
Comments from the patient
The doctor who had first examined my condition had to conclude that the tumor was inoperable at their institution, but kindly referred me to the Kyoto University Hospital, thinking that I had the best chance of finding a surgical solution there. At the University Hospital, the doctor in charge warned me that any medical operation to be performed on me would be a highly delicate one, but, as I have later learned, held frequent meetings with other specialists to discuss my condition and formulate a strategy. Ultimately, those doctors mobilized their collective knowledge and skills to ensure that the tumor was completely removed. I truly think that I am incredibly fortunate. I wish to take this opportunity to convey my profound gratitude to all those who helped me at Kyoto University Hospital.
