"Planing for the worst things, while hoping to get the best results!" Xiaojing Zhao, Director of Department of Thoracic Surgery at Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine told the reporter on the evening before surgery. Worthy of hope, good news came from the operating room after more than four hours’ waiting: a tumor weighing 942 grams was completely stripped from the 13-year-old girl from Fujian province Lili’s body. According to the doctors, the solitary fibroma at the junction of the neck and chest is rare in the world.

   On 9 a.m. of Feb 25, 2018, as Lili's left chest was cut open, a difficult operation began. The doctors should patiently and accurately follow the edge of the blood vessels and nerves to peel off a huge tumor entrenched at the junction of the neck and chest of the patient.

   It is the second time that the 13-year-old Lili confronted with the tumor. A year ago, Lili, who lives in Fujian, felt chest tightness. The hospital's examination results were like a thunderbolt --- her chest had a tumor. Fortunately, the operation was smooth and the tumor was not large. A minimally invasive thoracoscopic surgery removed the tumor. "Solitary fibrotoma", all the family members remembered this weird name on the discharge summary.

   But everything is not over. In the second half of last year, the chest pain recurred causing sleepless at nights. Examinations from local hospital found that the left side of Lili’s chest had a tumor of about 21 cm diameter, as large as a ball. From the exterior view, the girl's left chest wall was significantly fuller than the right. The tumor is still growing crazily.

   Secondary surgery would increase the difficulty of surgery, not to mention the tumor may violate the nerve and blood vessels too much that increased risk of surgery. Some doctor judged "She may not pass through the operation." But without surgery, continued expansion of the tumor may destroy the child just because of intolerable pain. In other words, the patient will be hard to live every day.

   "Go to Shanghai!" Upon recommendation of a local doctor, the family found Dr. Xiaojing Zhao, a surgeon who had been combating with thoracic tumors for more than 20 years.

   The surgery began at 9 o'clock, and the tumor was successfully stripped on 11:18. On 12:23, the vessels were bypassed ... ... Time ticking and the atmosphere in the operating room was quite tense.

   Surgeon Xiaojing Zhao is very clear before the surgery that it’s a "ruthless character "to deal with this time. Expansion of the growing tumor has firmly occupied the junction of the girl's neck and chest. There are a lot of important blood vessels in this position, once the cause of bleeding, life will be at risk. Even the life is preserved, important nerves may be damaged, leading to a series of disastrous complications such as tissues and organs injury due to blood supply damage, ischemia and so on.

   According to Xiaojing Zhao’s introduction, judging from the imaging, this huge chest tumor has oppressed the brachial plexus on the little girl’s left arm so that the left side of anonymous vein has no blood reflux. The tumor also completely surrounded the left subclavian artery ... ... Facing for such a complex tumor, many cases before surgery were uncertain, which could only be clear through exploration after opening the patient’s chest. It is a test for the surgeon's experience, skills, judgment and ability of spot decision.

   After opening Lili's chest, Xiaojing Zhao and spine surgeon Bin Chen carefully revealed all brachial plexus nerves, and the tumor was successfully and completely stripped from the surface. Further freeing of the left subclavian artery, the doctors found that it was almost surrounded by the tumor. Dissociation revealed that the telecentric end of the subclavian artery was only about 4 mm diameter with a considerable length of defect. The surgical team decided to abandon the artificial vascular replacement program. "To free a normal internal jugular vein as a bridge vessel, and then anastomose it with the left common carotid artery end-to-sidely!" Deputy Director of Thoracic Surgery Ching Ye thought of this wonderful plan occasionally.

   Thanks to Bin Chen for his familiarity with the anatomy of brachial plexus and the left subclavian, and also to Deputy Director of Department of Cardiac Surgery Ritai Huang for his techniques on anastomosis of small bridge blood vessels... ... On 1:18 pm, the operation was successfully completed, and the tumor was completely removed. The brachial plexus was completely reserved. The largest diameter of the tumor was 21 cm, weighing 942 grams. The pathological diagnosis showed "Solitary fibroma".

   Xiaojing Zhao told the reporter that most of these patients had no obvious symptoms of cancer, and many were accidentally found in the imaging examination. The tumor growth may cause chest pain, cough and so on. Difficult to be found early has brought great difficulty to surgery.

   Why is it willing to take over the operation which is likely to fail? The surgery team at Renji Hospital said that the girl's appetite for life impressed everyone." The child is very strong and we have to help her!" When facing with challenging surgeries, surgeons daring to challenge show great courage and interest. To get rid of the patients’ pain, the doctors' sense of accomplishment probably derived from this.

   (Due to privacy, the patient is a pseudonym. Medical staff named her "Lili", hoping the child will live smoothly)

    Chief reporter from “Wen Hui Bao Newspaper” WenjiaTang