This 32 year old female patient underwent left radical mastectomy due to ductal carcinoma on May 1990, and treated with FAM(5-fluorouracil, Adriamycin and Mitomycin C) regimen pogimen postoperatively. However, right cervical lymph node
enlargement
and
edema progressively developed since December 1993.
On April 1994, operation was performed, and findings were as followes;×4×5×7to 1×1×1 cm sized nultiple enlarged and hyperemic lymph nodes were scatterred throughout submandibular area to the junction of superior vena cava and pericardium,
and
partially invaded both anterior segmental lobe, sternum and both distal tip of clavicles. After radical dissection of the nodes of neck and mediastinal nodes, and wedge resection of both anterior segments of lung, and partial resection of both
clavicle
tips and total sternum. The both innominate veins and superior vena cava were partially obstructed by invaded cancer.
SVC reconstruction was done with preclotted 10×10×18mm Yshaped woven Dacron graft, which was anastomosed to the point of the junction of subclavian vein and jugular vein after cross clamping both veins and 2cm above the pericardial junction
with
one
arm clamp. After maintaining blood drainage to the SVC from the right side, left innominate vein was anastomosed with 4-0 Prolene continuous running suture.
Bone cement was used for resected sternal portion and clavicular ends were fixed to costal portion with 18 Gauge wires. The patient was trcated with radiation and chemotherapy after discharge, and there were no evidence of regrowing of the mass
nor
obstiuction of no antithrombotic therapy.
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