21st Century Necromancer-Chapter 658 - 654: Huge Mediastinal Tumor (Please Subscribe, Request Monthly Tickets)

Having finished the cake, Kohinata Kaori naturally focused all her attention on the medical case records that Chen Yu had given her.

As a doctor who had just arrived at the hospital, even though she graduated from the University of Tokyo and had further training in the United Kingdom, it was impossible for her to immediately have patients assigned to her. Thus, during this period, Kohinata Kaori had been helping other professors under the arrangements of Chen Yu, accumulating experience.

Far from being opposed to such arrangements, Kohinata Kaori actually found that assisting other professors and serving as a surgical assistant on the operating table allowed her to gain experience more rapidly.

While Chen Yu had arranged numerous opportunities for her during this period, this was the first time Chen Yu was personally mentoring her, which inevitably made Kohinata Kaori's heart flutter with excitement.

Eager to perform well in front of the senior colleague she admired, Kohinata Kaori naturally studied the medical case records that Chen Yu handed to her very seriously.

As she flipped through the records, Kohinata Kaori understood the patient's condition and also realized why Chen Yu had said that this case was very typical.

The patient was a 58-year-old man who had been admitted to the hospital due to chest tightness persisting for more than three months. A CT scan revealed a massive mediastinal tumor in his chest cavity that exceeded 12CM and completely enveloped the superior vena cava as well as the left and right anonymous veins.

She lifted the CT images from the case records towards the light source. Observing the huge tumor and the jelly-like tissue surrounding it, Kohinata Kaori couldn't help feeling amazed at the sight of this sizable mediastinal tumor.

The so-called mediastinum is a cavity located between the pleura of each side of the mediastinum, behind the sternum. There are many organs and tissues within the mediastinum, such as the thymus, heart, esophagus, trachea, etc., and it's possible for a variety of tumors and cysts to occur there, especially thymoma, which is clinically one of the most common mediastinal tumors.

However, when tumors and cysts develop in the mediastinum, about one-third of patients do not have any symptoms. Most cases are discovered during physical examinations conducted for other reasons. Chest pain, tightness, cough, and shortness of breath are the most common early symptoms of mediastinal tumors.

Mediastinal tumors aren't rare clinically, and surgical treatment is one of the more common treatment methods under normal circumstances, typically involving either thoracotomy or thoracoscopy.

A thoracotomy obviously poses a significant burden for the patient, but when the tumor is too large to be removed via thoracoscopy, thoracotomy becomes the only option to save the patient's life.

Given the size of the patient's tumor, this thoracotomy might involve opening the entire chest cavity to remove the tumor.

Chen Yu did not include a treatment plan in the medical records. Kohinata Kaori was unsure whether her mentor was testing her or wanted her to come up with a treatment plan. Nevertheless, she still pondered what to do for the surgery, driven by her instinct as a doctor.

Considering the position of the tumor, the patient should undergo surgery through a median sternotomy combined with a right anterolateral thoracic approach, which is to say, drawing a lateral 'T' on the patient's chest and opening up the right chest cavity.

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However, the tumor has already completely enveloped the superior vena cava, so it's very likely that a tumor thrombus has formed. If we aim for a thorough removal of the tumor, we might have to resect this section of the superior vena cava as well.

Vascular resection is a common procedure in surgery since the human body has so many blood vessels; apart from the main ones, other vessels are generally not irreplaceable.

But this superior vena cava happens to be one of the body's critical blood vessels and cannot be replaced.

Of course, being irreplaceable doesn't mean there's no solution. Using an artificial blood vessel to create a bridge, then replacing the original vessel with an artificial one after the tumor's removal, was the first idea that came to Kohinata Kaori's mind when she considered the possibility of a tumor thrombus. It's also the preferred method to handle the current situation.

While Kohinata Kaori was nibbling on a piece of cake and contemplating the surgical approach as she examined the medical records, a hand reached over from behind her and snatched the records away.

"A huge malignant thymoma, B2~C type, invading the superior vena cava and left and right anonymous veins, it's about 12cm in size, isn't it?" Dr. Daimon Michiko examined the CT images against the light, looking at this patient's condition, she instantly felt her hands itch to operate, "There's a possibility of a tumor thrombus in the superior vena cava. We should consider using an artificial blood vessel bridge between the left anonymous vein and the right atrial appendage to ensure cerebral and upper body blood return. After bridging, we'll isolate and remove the entire tumor, and then reconstruct the superior vena cava with an artificial blood vessel. How about giving me this surgery?"

"Dr. Daimon?" Kohinata Kaori turned around and, seeing the freelance doctor standing behind her, she quickly stood up to retrieve her medical records, "Give it back! That's my senior's patient. If you want to perform the surgery, go talk to him!"

Upon hearing Kohinata Kaori say this was Professor Chen Yu's patient, Daimon Michiko suddenly lost interest, "Professor Chen Yu's patient? Then forget it, I don't want to be his assistant!"

It wasn't that Daimon Michiko suddenly lost interest in the surgery, but she knew that Chen Yu would not easily cede the main surgeon role to her. She didn't want to make futile efforts only to end up assisting Chen Yu.

However, looking at Kohinata Kaori, an idea suddenly flashed through Daimon Michiko's mind, and her eyes lit up as she suggested, "How about you go tell Professor Chen Yu to let me take the lead in this surgery, and you can be my assistant? Isn't he your senior? If you talk to him, he would definitely agree, right?"

"Hey! Demon, that's enough, isn't it?" Because Daimon's pronunciation was close to 'demon,' Kaji Hideki had long since started calling Daimon Michiko 'demon,' "Professor Chen Yu already intended for Doctor Kohinata to assist him. Are you now disregarding everything for the sake of stealing a surgery, resorting to any means necessary?"

"Hmph, what do you know! With such a large tumor mass, any carelessness during surgery could easily damage the phrenic nerve and the recurrent laryngeal nerve, leading to worsened postoperative respiratory dysfunction. The lead surgeon must separate the tumor layer by layer and have a comprehensive understanding and control over the relative positions of the surrounding blood vessels, nerves, and organs. Do you think anyone can just perform this surgery?" Dr. Daimon shot back at Kaji Hideki but still returned the medical records to Kohinata Kaori.

Taking back the medical records from Daimon Michiko, Kohinata Kaori breathed a sigh of relief; perhaps to not show weakness in front of Daimon Michiko, she also spoke up, "Given the indistinct boundaries between the massive tumor and surrounding tissues, and the extensive adhesions to the organs, the complete resection rate of the surgery will be very low. Even if the tumor could be completely removed, the likelihood of postoperative recurrence and metastasis is high, and the prognosis is poor. A comprehensive treatment for the tumor that includes postoperative radiotherapy and chemotherapy is necessary."

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However, after she finished speaking, Daimon Michiko looked at her with some regret and shook her head, "It seems you've forgotten about the broad-spectrum anti-cancer drug developed by Professor Chen Yu. That new drug is about to hit the market. With such an extent of the tumor, as long as the patient takes the medication he developed after its removal, we can eliminate the possibility of postoperative recurrence and metastasis, so there's no need for radiotherapy and chemotherapy."

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