Yvonne Webb

Three lo­cal doc­tors have made med­ical his­to­ry.

The trio – urol­o­gist and lead sur­geon Dr Lall R Sawh, gen­er­al vas­cu­lar sur­geon Dr Steve Bud­hooram and Dr Peng Ewe, anes­thetist and in­ten­sivist – re­moved an eight-pound tu­mour from a 52-year-old man at the South­ern Med­ical Clin­ic, San Fer­nan­do, last week Wednes­day.

Ac­cord­ing to med­ical records, this is the largest tu­mour re­moved in the west­ern hemi­sphere and the sec­ond largest ever in the world.

Med­ical records which the doc­tors used to base their feat, show that the largest tu­mor suc­cess­ful­ly re­moved from a pa­tient weighed 5.018 ki­los (ap­prox­i­mate­ly 11 pounds) and was done dur­ing a five-and-a-half-hour surgery at the All In­dia In­sti­tute of Med­ical Sci­ences in New Del­hi, In­dia, break­ing the pre­vi­ous record of a 5.5-pound tu­mour re­moved at Sir Gan­garam Hos­pi­tal, al­so in In­dia.

The op­er­at­ing time for the lo­cal surgery was two hours whilst the­atre time was three hours, al­low­ing one hour for anes­thet­ic prepa­ra­tion and mon­i­tor­ing by Ewe pri­or to the knife to skin start time.

The three doc­tors sat down for an in­ter­view with mem­bers of the me­dia at Sawh's med­ical of­fice yes­ter­day and de­scribed the surgery as "touch and go" be­cause of a num­ber of pre-ex­ist­ing med­ical con­di­tions the pa­tient, whom they did not name, had.

Among them were car­diac is­sues and sco­l­io­sis, which caused the bend­ing of his spine. All to­geth­er, they said, that left lim­it­ed space for the doc­tors to work to re­move the tu­mour suc­cess­ful­ly.

Sawh equat­ed the eight-pound growth to that of the size of a woman's stom­ach when she is some months preg­nant.

He said the growth may have de­vel­oped over a year but the pa­tient's "self-di­ag­nosed" used a reg­i­men of herbal med­i­cine to cure his sud­den weight loss and ex­tend­ing stom­ach. He said strange­ly, the pa­tient said he had no pain nor did he pass blood in his urine as is usu­al with a tu­mour.

"It is amaz­ing some­body could ac­tu­al­ly car­ry that around for a year and not see some­thing is wrong. I am loos­ing weight, not feel­ing my usu­al self, in this day and age peo­ple still take things for grant­ed," Sawh said.

On­ly a few weeks ago, when the pa­tient start­ed ex­pe­ri­enc­ing se­vere ab­dom­i­nal pain, he sought Sawh's ser­vices. Sawh said from the mo­ment he saw him he knew if the growth was not re­moved from the pa­tient's left kid­ney he would have died.

"When we saw his scans, we re­alised we had big chal­lenges and for the first time in my 35-year med­ical ca­reer, I made a man sign a con­sent form that he could die on the op­er­at­ing ta­ble," Sawh said.

Bud­hooram added; "The tu­mour was so huge it was push­ing the di­aphragm, the left lung and the heart up. The growth was al­so go­ing down in­to his pelvis, so this thing oc­cu­pied the en­tire left half of the ab­domen and even pushed his ma­jor blood ves­sels, which are nor­mal­ly in the mid­dle, to the right."

He said the vein of the tu­mour was ac­tu­al­ly larg­er than the vein go­ing to the heart, which posed an­oth­er chal­lenge.

Sawh in­ter­ject­ed: "So the chal­lenge was space and as Dr Bud­hooram ex­plained, if you make one er­ror with the blood ves­sels that is death on the op­er­at­ing ta­ble."

Anaes­thetist Ewe said he too faced a num­ber of chal­lenges to put the pa­tient to sleep be­cause the pa­tient had a large mass com­press­ing on the heart and a pre-ex­ist­ing car­diac is­sue.

"So we had to get the car­di­ol­o­gist to come in and see him and do and ECHO so I could as­sess and an­tic­i­pate what prob­lems I would face with him.

"Al­so, with the big mass press­ing against the di­aphragm, squash­ing the base of the lungs, you had to ad­just how you ven­ti­late him be­cause the lungs would not have much room for ex­pan­sion af­ter that big mass comes up.

"So to put him to sleep, we ob­vi­ous­ly had to do a lot of in­va­sive mon­i­tor­ing. We had to put in a lot of lines to mon­i­tor the blood pres­sure and the flu­id sta­tus. Be­cause of the pre-ex­ist­ing heart con­di­tion we couldn't over­load him with liq­uid be­cause his heart would not have been able to take the strain," Ewe added.

The doc­tors said they had to wait for the right time to op­er­ate as a re­sult of those ex­ist­ing con­di­tions.

Nev­er­the­less, on De­cem­ber 2, af­ter Ewe was able to pre­pare and put him to sleep, Sawh and Bud­hooram, ably sup­port­ed by scrub nurse and head op­er­at­ing the­atre nurse, Su­san Ma­haraj, and her team of Mon­cy Math­ew and the the­atre staff, went to work on the pa­tient from east Trinidad for three hours to un­der­take one of the riski­est chal­lenges of their ca­reers.

"We did him on Wednes­day, he was kept in the In­ten­sive Care Unit (ICU) for the first 24 hours and by Sat­ur­day, he was home, three days post-op­er­a­tive­ly," Sawh said.

The re­moved tu­mour spec­i­men was weighed and sent to the labs for analy­sis.

In terms of his sur­vival, Sawh said they have to wait for the his­tol­ogy from the labs and if all his or­gans were fine then that would be a sign he was cured. How­ev­er, if the cap­sule has been breached then he may have to do ad­di­tion­al chemother­a­py.

The doc­tors said the case would be pub­lished in an in­ter­na­tion­al med­ical jour­nal.