Doctors at Sir Ganga Ram Hospital successfully removed a tumour, roughly the size of a shoe box, from the left thigh of an 18-year-old youth and managed to save his leg from amputation.
“The patient, Praveen Kumar Gupta, came to us on December 26, 2018, and said that swelling had appeared on his left thigh in 2012, and gradually increased in size till it measured 37 cm x 18 cm x 12 cm. It was so huge and painful that he was not able to walk or sit properly,” said Brajesh Nandan, Orthopaedic Onco-Surgeon, Sir Ganga Ram Hospital.
“Due to pressure on the nerves and blood vessels, there was weakness and loss of sensation in the limb. Mr. Gupta approached many hospitals, which advised amputation of the leg, for which he was not ready,” said Dr. Nandan.
Saving the limb
Doctors said the challenge was not only to successfully remove the tumour but also save the limb.
To solve this issue, a medical board was formed comprising Departments of Orthopaedics, Vascular Surgery, Plastic Surgery and Anaesthesiology.
“Preservation of the limb along with successful removal of the tumour was a big challenge. According to reported literature, this was the largest tumour ever removed from inside the thigh, without compromising the limb. Before this, a tumour measuring 32 cm x 13.5 cm x 5.5 cm was removed from a patient by the University of Miami in 2014,” noted a release issued by the hospital on Wednesday.
Blood supply
“The tumour had a rich blood supply, making it highly vascular in nature. Before the removal, our team performed a procedure called pre-operative embolisation, a night before surgery. We blocked the blood supply to the tumour to reduce blood loss during the surgical excision. The main challenge was that blood supply of the tumour was adjoining the main blood supply of the lower limb. Any untoward incident could have led to disastrous amputation. Using road-map guidance software, we successfully blocked the main blood vessel supplying blood to the tumour without compromising blood supply to the limb,” said Ambrish Satwick, Vascular and Endovascular Surgeon, Sir Ganga Ram Hospital,
After cutting blood supply to the tumour, the patient was taken for surgery, which was performed on January 3, 2019, by a team of seven surgeons.
“We dissected the tumour, which was strongly adherent to surrounding vital structures, blood vessels and nerve. The team encountered a lot of blood vessels supplying blood to the tumour during the surgery. They were carefully tied,” noted the release.
“This was a challenging case for anaesthesia because it was a long surgery performed in the prone position (lying on abdomen), which has its own problems. Blood loss was anticipated, but managed with meticulous surgical and anaesthetic technique,” said Jayashree Sood, chairperson, Department of Anaesthesiology, Pain and Perioperative Medicine, Sir Ganga Ram Hospital.
The surgery took nine-and-a-half hours and only one unit of blood was transfused.
The patient recovered well after the surgery and started walking with the help of some aid just three days after the operation, stated the hospital.
