Lam Adam, Campbell Nicholas P, Russell Hyde M, Krantz Seth B
Department of Surgery, University of Chicago, Chicago, Illinois.
Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois.
Ann Thorac Surg Short Rep. 2023 Jan 4;1(2):235-237. doi: 10.1016/j.atssr.2022.12.011. eCollection 2023 Jun.
We present a case of an advanced squamous cell carcinoma encroaching on a patient's left internal mammary artery bypass graft. Tumor board consensus was to proceed with 2 cycles of neoadjuvant chemotherapy followed by resection. Intraoperatively, the left internal mammary artery bypass could not be safely dissected from the adjacent pleura, but frozen sections were negative for malignant transformation. Final pathologic examination showed a complete pathologic response to neoadjuvant chemotherapy, and surveillance imaging is now negative for recurrence 5 years postoperatively. Although malignant neoplasms invading into adjacent vasculature can post technical challenges during an operation, neoadjuvant therapy can downstage these tumors and make resection feasible without added morbidity.
我们报告一例晚期鳞状细胞癌侵犯患者左乳内动脉搭桥移植血管的病例。肿瘤委员会达成的共识是先进行2个周期的新辅助化疗，然后再进行手术切除。术中，无法安全地将左乳内动脉搭桥血管与相邻的胸膜分离，但冰冻切片显示无恶性转化。最终病理检查显示对新辅助化疗有完全的病理反应，术后5年的监测影像显示无复发迹象。尽管恶性肿瘤侵犯相邻血管会在手术中带来技术挑战，但新辅助治疗可以降低这些肿瘤的分期，使切除可行且不会增加发病率。
