The medical team of Fuda Cancer Hospital Haizhu Branch successfully removed a giant abdominal tumor for a female patient
A women with giant abdomen walked into the office of President Xu Kecheng
In the morning of March 25, 2016, a “heavily pregnant” woman, accompanied by her family members, walked into the office of Xu Kecheng, Chief President of Fuda Cancer Hospital. The patient surnamed Lin, 29 years old, is from Lianjiang, Guangdong. She told President Xu that she was not pregnant; instead there was a big tumor in her abdomen. She could feel that the tumor was still growing and she was having breathing difficulty. She entreated Fuda Cancer Hospital to help her.
After studied Ms. Lin’s examination result, Prof. Xu Kecheng was shocked as the abdominal tumor was so big that it has occupied her whole abdominal cavity. The organs in abdominal cavity were heavily compressed. The patient was having breathing difficulty, urination difficulty, hydronephrosis, injured renal function and edema in the lower limbs. Due to long-term consumption of tumor, she was emaciated and pale but her eyes revealed her desire for life.
“President Xu, doctors at the local hospital and several major hospitals in Guangzhou said I cannot get operated. Please help me. I’ve got to stay alive because I have two kids to look after...”
Looking at the patient with a giant abdominal tumor reminds President Xu Kecheng of these patients with giant abdominal tumor who have been successfully treated at FUDA. They are Peng Ximei, Bingbing, etc. He decided to challenge the impossible once again and try all out to help her.
At noon on the same day, Ms. Lin was sent to Fuda Cancer Hospital Haizhu Branch and was admitted for postoperative recurrence of abdominal liomyoma.
The nightmare started three years ago
Ms. Lin is from Heliao town, Lianjiang City, Guangdong Province. In December 2013, Ms. Lin, 26 years old, felt abdominal distention accompanied by dull pain. She did ultrasound and CT scan at the affiliated hospital of Hainan Medical University and was found to have an enormous space-occupying lesion in the abdomen, which was suspected to be benign tumor. Then she underwent tumorectomy. The pathological result showed (abdominal wall) gastrointestinal mesenchymal tumor, likely to be liomyoma. After the operation, she had paroxysmal left lower abdominal pain occasionally, but she did not pay any attention to it. In October 2015, she was found to have mass in the previous tumor bed during her re-examination. Tumor recurrence was detected and the tumor was growing rapidly.
Ms. Lin was very afraid. She was even dreading to imagine what the consequences would be if the tumor continued to grow. The nightmare had been hanging over her and her family members.
“Maybe I consult with some major hospitals in Guangzhou.” it suddenly occurred to her.
However, things did not go well as they thought. They consulted several major hospitals in Guangzhou, but doctors all said that the tumor was too big to be resected.
She saw a glimmer of hope after being admitted by FUDA
As the tumor grew bigger, she started to have such symptoms as constipation and dysuria. Her husband proposed, “We may go to Beijing and have a try. There will always be a way out.” When Ms. Lin was hesitating the next step forward, what her mother-in-law said caught her attention “Several days ago, I watched a TV program. It tells about how a hospital successfully treated a girl who have giant abdominal tumor. I remember the hospital is called Fuda Cancer Hospital. “Should we have a try in that hospital?” Ms. Lin agreed to her mother-in-law’s proposal and come to Guangzhou Fuda Cancer Hospital with her family. On March 25, Ms. Lin was admitted into Fuda Cancer Hospital Haizhu Branch.
Face up to the difficulty
Ms. Lin completed relevant examination upon admission. The findings of CT scan are as follows: postoperative recurrence of abdominal liomyoma is considered; adjacent intestines, bladder and uterus are compressed and adhered; the inferior pole of left kidney is compressed; bilateral ureters are compressed and narrowed. The abdominal aorta and bilateral illiac arteries and veins are compressed; small nodular lesions are noted in the inferior lobe of right lung; hydronephrosis is noted in bilateral pelvises and the superior segment of ureter and the left side is more significant, which are considered to be caused by the compression of the middle-lower segment of both lower ureters; the left kidney is enlarged; the left kidney function is damaged; varicosity is noted in the space between the inferior margin of spleen and the abdominal mass; varicosity is noted in pelvic cavity...ECG test showed sinus bradycardia.
As the tumor showed rapid progression, Ms. Lin had difficult defecation. Patient’s symptoms together with the erect abdominal plain radiograph showed the possibility of incomplete intestinal obstruction.
The Vice President Li Haibo, Chief Physician Wang Jiannan, Visiting Doctor Zhou Zhanchun, Visiting Doctor Leng Yin, Resident Doctor Lin Qiongmei, Resident Doctor Li Chunli made an in-depth study on Ms. Lin’s condition and held preoperative discussion.
Prof. Wang Jiannan noted that the operation carries four major risks:
1. The surgical incision will be very hard to heal since the tumor is too big and needs to be fully exposed during the operation;
2. There isn’t a clear demarcation between the tumor and adjacent organs and tissues. The adjacent blood vessels, kidney, ureters, intestines, uterus, and bilateral adnexa might be easily injured; hence, revascularization, colostomy, pyelostomy might be done during the operation;
3. The postoperative recurrence rate is high and repeated operation may need to be done due to incomplete resection of tumor;
4. The risk of intraoperation massive haemorrhage is high; hence, abundant blood product should be prepared. The chance of having extensive intestinal adhesion is high; hence, anti-adhesion treatment needs to be done before closing the abdominal cavity.
Dr. Li Haibo noted that the giant abdominal tumor is compressing important visceral organs such as heart, blood vessels, kidneys and intestines, causing functional disturbance. Patient will die of multiple organ failure if the operation cannot be done. Other treatments, such as radiotherapy, chemotherapy, mini-invasive ablation are of no help to the patient. Only surgical resection of tumor can save the patient’s life. Fortunately, the tumor is only compressing not invading the important organs in the abdominal cavity. Impaired renal function is caused by urination difficulty that is caused by tumor compression. The impaired renal function can be reversed if the compression is relieved. He mentioned that considering that the patient can tolerate major operation as she was at her prime and the level of tumor malignancy was not high, the patient had the opportunity to have the tumor resected and enjoy a long-term surviving. Though the operation carries great risk, the reward was worth the risk as long as adequate preoperative operation was made.
The anesthetist Fang Gang believed that the reward of the operation was worth its risk. The consequence would be fatal if operation was not done at an early date.
After three rounds of discussion, the medical team of Fuda Cancer Hospital decided to do the following procedures for the patient: bilateral ureter stenting+exploratory laparotomy+abdominal tumor resection+colostomy. The operation was scheduled to take place on April 20.
The giant tumor is removed
After the attending doctor explained to Ms. Lin and her family member the operation plan and the possible risks entailed, Ms. Lin said, “I don’t have any way out. I want to have a try regardless.”
At 8:00a.m., of April 20, Ms. Lin was wheeled into the operation room. The operation room was in tension. The surgeons were Prof. Wang Jiannan and Vice President Li Haibo; the assistants were Zhou Zhanchun and Leng Yin. Anesthesiologist Fang Gang was in charge of intraoperative management.
As expected, the giant tumor was found to have occupied the abdominal cavity and it’s impossible to have a full view of the tumor after the abdominal wall was cut open. A slight move would cause bleeding as the tumor was rich in blood vessels. Shortly after the operation began, the amount of bleeding reached about 1,000ml. The operation was a big test of perseverance and courage to the surgeons. The surgeons, bold but cautious, exposed the tumor while stopping bleeding. The anesthesiologist and the surgeons acted in close coordination. The anesthesiologist kept the surgeons informed of the patient’s vital signs and gave timely blood transfusion and fluid infusion to patients, which have bought more time for surgeons.
The operation was ongoing: to separate abdominal wall adhesion, to separate angiosynizesis, to separate ureter adhesion, to separate bladder adhesion, to separate intestinal adhesion, to remove part of the invaded intestine, to do intestinal anastomosis, to do hemostasis by ligation, in the end, to do colostomy. Unconsciously, eight hours passed, with the concerted effort of all medical staff, the tumor was finally removed.
The largest mass removed weighs up to 6.135kg
It took a dozen of operation staffs eight hours to complete the operation. The amount of bleeding, blood transfusion, blood plasma, platelet, albumin were 6,300ml, 5,000mg, 3,000ml, 1 mechanical production unit, 90g respectively. A total of over 10,000ml infusion and transfusion were made. The largest mass removed weighed up to 6.1kg. These startling figures represent the return of a life.
When Prof. Wang Jiannan walked out of the operation room, he took a deep breath and said to the patient’s family, “The operation is very successful. The patient has had stable vital signs throughout the operation. Please rest assured.”
When Dr. Li Haibo showed the removed mass to the patient’s family members, they were full of surprise, happiness and appreciation. They never thought that there was such a big mass in the patient’s abdomen. They are so amazed that the tumor that was deemed to be unresectable by the nationally renowned hospitals is removed at Fuda Cancer Hospital. They are so happy that the patient’s life gets extended. They are even more grateful for the respect that the medical team of Fuda Cancer Hospital has shown to life.
At 10p.m., five hours after the operation, Ms. Lin, who was still on respirator has been wide awake from operation in the ICU. Her vital signs were stable and intraperitoneal drainage was becoming less. After completing relevant examinations, Li Haibo, the Vice President of FUDA, removed her tracheal intubation, which means that her life was out of danger. He said, “We are greatly relieved to see that she has pulled through the difficult situation and is having stable vital signs now. What we have done have been very rewarding. ”
Xu Kecheng, the Chief President of FUDA, visiting Ms. Lin
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