After 4 Failed Surgeries, A 4 Kg Tumor of Size 30 X15cm Removed from a 46-year-old Man at Zen Hospital
Mumbai: A team headed by Dr Tanveer Abdul Majeed [Surgical Oncologist] and Dr Santosh Palkar [Urologist] successfully extracted a 4 Kgs Tumour of Size 30 X15cm, and saved the life of a 46-year-old man from Chhattisgarh with a penguin-like stomach, and 4 failed surgeries for Retroperitoneal Sarcoma.
Retroperitoneal Liposarcomas are tumours seen in the abdomen (tummy) and pelvis and usually presents with gradual onset bloating, as the size increases the symptoms become more severe and may reach a state of respiratory distress.
A 46-year-old man named Chhattisgarh, a manual farm labourer was in great distress due to his inability to earn his daily bread due to associated abdominal bloating and breathlessness which gradually progressed to a state where he was unable to walk, sit and carry on with his daily chores. In the past, he had undergone 4 surgical procedures for tumour excision at various centres over a span of 4 years. Due to the associated invasion of major vascular structures, the tumour was excised leaving behind, major portions over blood vessels due to the associated risk of bleeding. The magnitude of his distress was accentuated due to COVID – 19 and associated lockdown which led to a gradual decline in his general condition. He was referred to Zen Hospital at this juncture with low-performance status due to the associated bulk of tumours causing severe pressure symptoms.
Dr Tanveer Abdul Majeed, a Surgical Oncologist, Zen Multispecialty Hospital, Chembur said “On arrival after 36 hours of gruelling travel by train he reported to the Accident & Emergency for abdominal distension & breathlessness caused by a penguin like a stomach, he was admitted in the high-density unit [HDU]. He was evaluated with a fresh contrast-enhanced CT scan which revealed a very large tumour arising in the left side in close relation to the left kidney going across the whole abdomen encasing and compressing the right ureter and Right External Iliac vessels. Since the tumour was in close proximity to the left kidney a DTPA Scan was performed to assess the function of both the kidney as very commonly it arises from Gerota’s Fascia [Fat around the kidney] which may need the removal of the kidney to prevent recurrence of the tumour. He was advised Surgical Excision with possible excision of the left kidney and vascular resection and reconstruction.
Dr Santosh Palkar, Urologist, Zen Hospital said, the patient was prepared for Surgical Excision after careful preoperative evaluation with a vascular surgeon standby. He also underwent preoperative breathing exercise, adequate blood reservation and bowel preparation. Under general anaesthesia, his both ureters were stented to identify them during the surgical procedure so as to prevent accidental damage. The abdomen was opened using a midline Incision. A large tumour arising from the left kidney extending across the whole abdomen across to right side in between the small bowel extending still further to encase the right ureter and right external iliac vessels to 180 degrees The entire tumour was removed along with Intra perinephric excision of the left retroperitoneal sarcoma along with right ureterolysis. The right external iliac vessels were dissected and had to be repaired with vascular sutures due to intraoperative injury. The operation lasted for 7 hours due to significant blood loss he needed intraoperative and postoperative blood replacement. It was a very complicated and risky operation and required significant support from the anesthesiology team is trying to maintain low blood pressure to minimize blood loss and at the same time maintain it adequate enough to prevent the catastrophe of low blood pressure. He was shifted to Intensive care and ventilated overnight. A tumour measuring 30 x 15 x 15 cms and weight of 4.75 kgs was removed. The patient was removed from the ventilator after optimal blood and fluid replacement. He stayed in the hospital for about 20 days and was discharged. He is advised not to lift heavy weights for 3 months and use to an abdominal binder to allow healing of his abdomen wound.
“I am a farmer from Ambikapur, Chattisgarh. There are 7 members including me in my family. My wife, 2 kids, brother, mother, and father were worried when they saw my increased stomach girth, I started looking like a penguin. I was embarrassed to go out and work in the field as everyone would ask what’s wrong with me. Not only this, but I also encountered intense stomach pain that made me unable to perform the daily chores. I couldn’t walk, sit, sleep and eat properly. We were shattered on knowing about this rare tumour as we weren’t aware of it at all. After 4 failed surgeries in my hometown, I came to Mumbai as my health continued to deteriorate. I am thankful to the doctor at Zen Hospital for removing the tumour and saving my life. I am grateful to my family as well for taking care of me. Since I was unable to go farming, my brother would do it, alone. I have resumed my daily routine now and can do all the activities with ease. I sincerely appeal to each and everyone to take utmost care of their health and do not neglect any signs of pain,” conclude the patient Sarvan Kumar.
