By Bilal Kuchay
In a rare surgery, doctors in India removed two football-sized tumours from a Tanzanian patient’s liver and rectum.
Omar Salim, 32, had been suffering from severe abdominal pain for past one year.
He underwent a seven-hour complicated surgery at Sir Ganga Ram Hospital in New Delhi on January 31.
Two football sized tumours, weighing together over 3kg, were removed from his liver and rectum.
Dr Vivek Mangla, consultant gastrointestinal and hepatobiliary surgeon who led the team of doctors that carried the surgery, said: “It took us nearly seven hours to remove the tumours.
“One of the tumours — 15x14cm in size and weighing 1.2kg — was resected from the liver. The other — 24x13cm in size and weighing 1.9kg — was removed from the patient’s rectum.”
A previous attempt at surgery in his country had failed in view of the extent of the disease.
He travelled to India and visited Sir Ganga Ram Hospital in October 2017 with complaints of a large mass in abdomen and severe abdominal pain.
Dr. Mangla explained: “Salim was initially evaluated with a CT scan of the abdomen which revealed that there was a large mass in relation to the rectum with compression of the urinary bladder and extending to the anterior abdominal wall upto the level of the umbilicus.
“There was another large mass in the left lobe of liver occupying nearly the whole of the left upper abdomen.
“Biopsy revealed a diagnosis of rectal Gastrointestinal Stromal Tumor (GIST). Though GISTs are seen fairly commonly in the intestinal tract but only about five percent of all cases of GIST occur in the rectum.”
After discussing the case in a multidisciplinary team,a targeted therapy was given to the patient for three months.
On re-evaluation, it was found that there had been a slight decrease in the size of the mass and there had been no progression of the disease.
After detailed discussion with the patient’s family and multidisciplinary team, Salim was planned for surgery.
Dr. Mangla admitted there were multiple risks involved in the surgery including risk of major blood loss, damage to vital structures in the area and nerves supplying the muscles which work to ensure proper urinary function.
He said: “The management of large tumours of the rectum is particularly challenging. These tumours tend to be very vascular and surgery for these entails the risk of major blood loss.
“Presence of vital structures in the area including the urinary bladder and ureters, and nerves supplying the muscles which work to ensure proper urinary function increases the complexity of the operation.
“Another challenge was that the tumour was quite close to the muscles which help in maintaining continence, ability to control the passage of stools, and it required very careful surgery to ensure that the tumour was removed completely but at the same time, the muscles required to maintain continence to stools could be preserved with a special technique more often used in treatment of distal rectal cancer.
Despite the extent of the tumour and surgery, Dr Mangla said there was no requirement of any blood transfusion during the surgery.
He added: “To the best of our knowledge, this is the first report of a synchronous resection for such a large rectal GIST with a solitary large liver lesion.”
The patient subsequently recovered uneventfully and has been discharged from the hospital now.