A multi-disciplinary team of specialists at Apollo Hospitals, Chennai, has performed a remarkable surgery on a 50-year-old Bangladeshi patient to remove a rare recurrent chest wall tumour (Chondroscarcoma). The tumour was safely removed and the chest wall was reconstructed using synthetic materials and back muscle tissue. A new chest wall was formed after the sternal bone was repaired with bone cement wrapped in a mesh.
Mr. Abdullah, a 50-year-old Bangladeshi gentleman, came to Apollo Hospitals in Chennai with a tumour in his rib and chest wall. The tumour began as a swelling in his chest wall in November 2020, and he was assessed and operated on in December 2020 in his hometown at Bangladesh. The tumour was discovered to be a chondrosarcoma, which is a cancerous tumour that arises from the cartilage that joins the rib to the spine.
The surgeon at Bangladesh had removed the tumor along with his left first and second rib. Unfortunately, his tumour recurred within 6 months of surgery, in May 2021. It was much larger and growing rapidly this time. Mr. Abdullah decided to seek opinion from centers in India as there was no expertise and infrastructure support to perform such an operation in Bangladesh.
The most effective treatment for chondrosarcoma is surgery. However, the tumour on the chest wall was enormous and widespread, involving vital neck structures and huge veins originating from the heart.
Speaking about the complexity of the disease, Dr. Ajit Pai, Senior Consultant in Surgical Oncology and Robotic Surgery, Apollo Hospitals, Chennai said, “The lesion comprised of three components, one each in the neck, chest wall, and inside the chest, squeezing the key structures in the neck, the heart, lungs, and the major vessels. The patient had started to develop difficulty in breathing, difficulty in swallowing and chest pain. Multiple centers across India were hesitant to offer surgery to him owing to complexity of the lesion and the perceived low probability of success.”
He added, “At this juncture, he reported to us and we thoroughly evaluated him. His scans revealed a tumor in the chest wall and neck, with involvement of the sternum (central chest bone), collar bone, ribs, important vessels in the chest and neck (aorta, carotid and subclavian vessels) and the wind pipe (trachea).”
Based on a detailed study done by a team of experts headed by Dr Ajit Pai, Senior Consultant in Surgical Oncology with support from the Dr Rajarajan Venkatesan, Vascular surgeon, Dr MM Yusuf, Cardiothoracic Surgeon, Dr Arun Kannan, Orthopedic Surgeon, Dr. Chepauk Ramesh, Plastic and Reconstructive Surgeon and Dr Bhaskar, Cardiac Anesthetist, the surgery was planned and performed.
The patient underwent a 14 hour surgery on the 25th of February 2022. The tumor, along with part of the sternum, 3 ribs on each side and collar bones was removed completely. The vital blood vessels were preserved because of careful preoperative planning and meticulous surgery. The chest wall was reconstructed by the plastic and reconstructive surgeon with synthetic materials and tissue from the back muscles. The sternal bone was reconstructed with bone cement encased in a mesh and a new chest wall was created.
Ms. Preetha Reddy, Vice Chairperson, Apollo Hospitals Group said, “We have always believed that harnessing the right technology and combining it with medical expertise helps work miracles. This case is one such example. We are happy to be setting high standards in patient care. At Apollo Hospitals, we put the patient first in all we do and deliver world-class treatment that is both accessible and affordable. We are convinced that such medical milestones will alter the lives of many more individuals who are in dire need.”
Mr. Abdullah recovered well in the post-operative period with intensive post-operative care in the CCU. The Biopsy report confirmed that his Cancerous tumour was removed completely with negative margins. His surgery and uneventful recovery have given him a new lease of life and a prospect of cure, which seemed a remote possibility a few months ago.
