What to do if thyroid cancer has rare metastasis? Sichuan University of Surgery combines multiple disciplines to help with precision minimally invasive treatment

Recently, a multidisciplinary team from the Department of Head and Neck Surgery and the Department of Thoracic Surgery at Sichuan Cancer Hospital successfully performed precise minimally invasive treatment for a patient with mediastinal metastasis of thyroid cancer through robot-assisted surgery.

Xiao Li, who was in his 20s, developed multiple lymph node metastases in the neck and mediastinum after his first thyroid cancer surgery. Traditional surgery faced difficulties such as severe trauma and high risks.

Professor Wang Zhaohui's team quickly initiated multidisciplinary diagnosis and treatment (MDT), and worked with Professor Zhuang Xiang from the Department of Thoracic Surgery to develop a robot-assisted laparoscopic surgery plan. With the help of three-dimensional imaging and precise control of the robotic arm, they completely cleared the metastatic lymph nodes in the neck and mediastinum, and successfully protected the sternum and large blood vessels, achieving the goals of tumor radical cure and minimally invasive surgery.

The patient had no complications after the operation and was discharged from the hospital after the tube was removed 3 days later . This fully demonstrated the advantages of minimally invasive treatment and the technical capabilities of robotic surgery in the treatment of complex lesions, as well as the precision medical strength of Sichuan University of Science and Technology's deep integration of multidisciplinary collaboration and minimally invasive concepts.

Multidisciplinary consultation: locking down the "mediastinum minefield"

Xiao Li (pseudonym), who is in his 20s, never expected that after being diagnosed with papillary thyroid cancer a year ago and undergoing total thyroidectomy + central lymph node dissection and two rounds of radioactive iodine therapy and endocrine therapy at a local hospital, he would have metastatic lymph nodes in his neck and thoracic mediastinum. Cancer cells were lurking in Xiao Li's neck and chest like a string of "invisible bombs", which made him and his family very nervous. In the end, they chose to come to the clinic of Professor Wang Zhaohui of the Department of Head and Neck Surgery at Sichuan Cancer Hospital for further treatment.

Professor Wang Zhaohui quickly organized a multidisciplinary team (MDT) to evaluate the condition. Experts from the Department of Head and Neck Surgery, Department of Thoracic Surgery, Department of Imaging, Department of Nuclear Medicine, and Department of Pathology conducted an in-depth discussion on Xiao Li's condition. The mediastinal lymph node lesions of patient Xiao Li are located in front of the aortic arch, that is, in the middle of the sternum, where large blood vessels, nerves, and trachea intersect. Traditional surgery requires splitting the sternum, which is traumatic and slow to recover; and laparoscopy is worried about "not being done cleanly." After excluding lung metastasis and bone metastasis, the multidisciplinary team decided to use robot-assisted laparoscopic descending mediastinal lymph node dissection to "thoroughly clean" the cancer cells, completing precise dissection in the "vascular maze" while achieving the purpose of minimally invasive and volume preservation .

Thyroid cancer is divided into papillary thyroid cancer, follicular thyroid cancer, medullary thyroid cancer and anaplastic thyroid cancer according to pathological types. Papillary thyroid cancer is often called "happy cancer" because of its good prognosis and high survival rate.

Cervical lymph node metastasis is more common in papillary thyroid carcinoma, while mediastinal metastasis is relatively rare. The mediastinal region is divided into the upper and lower mediastinum, of which lower mediastinal metastasis is even rarer. The lower mediastinum is known as the "life center" of the human body because of its dense distribution of large blood vessels, trachea, and nerve bundles. When papillary thyroid carcinoma metastasizes to the lower mediastinum, treatment faces severe challenges . Patient Xiao Li suffers from papillary thyroid carcinoma with metastasis to the cervical and lower mediastinal lymph nodes.

PET/CT showed cervical and mediastinal lymph node metastasis

"Even for malignant tumors with a good prognosis, rare metastases can make treatment much more difficult," said Professor Wang Zhaohui. "Our value lies in minimizing the clinical risk of this kind of 'unhappiness' through precise assessment and personalized treatment plans."

"Precision knife skills" on the operating table: robots break through the vascular maze

On the day of the operation, Professor Wang Zhaohui of the Department of Head and Neck Surgery took the lead in completing the cervical lymph node dissection, clearing the way for subsequent operations. Then Professor Zhuang Xiang of the Department of Thoracic Surgery and his team performed a robot-assisted thoracoscopic mediastinal lymph node dissection for Xiao Li.

" The advantages of robot-assisted operation are: first, it can magnify the local details of the tissue and make the vascular texture clearly visible. Compared with laparoscopy, the field of view is wider and it is easier to observe some tiny structural details. Second, the rotation and mobility of the robotic arm are higher, so it is easier to reach where we want to go, and it causes less trauma to the patient." Professor Zhuang Xiang introduced that Xiao Li's mediastinal lymph node metastasis was adhered to the surrounding blood vessels. Ordinary laparoscopic surgery has the risk of vascular damage, but robot-assisted surgery successfully avoided this risk and achieved the dual goals of minimally invasive and radical cure .

Six lymph nodes were found in the cleared mediastinal tissue, all of which were metastases of papillary thyroid carcinoma. After 8 hours, the metastatic lymph nodes were finally completely removed, and the robotic surgery reduced the amount of blood loss from 200 ml to several dozen ml. The patient's nerves and large blood vessels were well protected during the operation, and there were no complications after the operation. Compared with the traditional sternotomy, Xiao Li only had a scar on his neck, which protected the integrity of the sternum, saved the time and pain of the bone healing process, and greatly shortened the hospitalization time. Xiao Li was extubated 3 days after the operation and was discharged smoothly.

Advantages and challenges coexist: the future of robotic surgery

"The robot is not cold steel, but an extension of the doctor's hands." The success of this operation marks an advanced breakthrough in the treatment of mediastinal metastasis of thyroid cancer at Sichuan Cancer Hospital.

Although robotic surgery has shown significant advantages in the treatment of mediastinal metastasis of thyroid cancer, its development still faces multiple challenges. The robotic arm cannot transmit the perception of the softness and hardness of the tissue. Doctors can only judge by the amount of surgery and training experience, and rely on accumulated experience to control the strength and avoid damage. Therefore, robotic assistance is also a "delicate job". Tactile feedback is a future direction of robotic-assisted surgery . In the future, it is expected to develop tactile sensing technology, combined with AI algorithms to simulate tissue mechanical feedback, to achieve "visibility" and "touchability".

Professor Zhuang Xiang said that the robot-assisted surgery system has gradually been widely used in the field of thoracic surgery due to its significant advantages such as minimally invasiveness, fast postoperative recovery and high precision, and has become the preferred option for tumor clearance surgery . However, when the lesion cannot be completely removed after preoperative evaluation and other minimally invasive techniques, sternotomy as the ultimate solution still has irreplaceable clinical value in ensuring the radical cure of the tumor.

"The wound is small, but the hope is great." This sentence may be the best interpretation of the ingenuity of doctors - using technology to break through the forbidden zone and using warmth to heal people's hearts. The progress of medicine is always the dual arrival of precise calculation and humanistic care.