The Surgical Gastroenterology (SGE) Department at Thiruvananthapuram Government Medical College hospital is celebrating the 10th year of the first surgery it performed for Carcinoid syndrome with Carcinoid heart disease, which also turned out to be the first such surgery in the country.
The 39-year-old housewife had come to the Medical College with flushing attacks and swelling of the feet and face where she was diagnosed as having Carcinoid syndrome with Carcinoid valvular heart disease producing cardiac failure.
Carcinoid tumours are a type of slow-growing cancer that can arise in several places throughout the body. A subset of neuroendocrine tumours, these usually begin in the digestive tract or in the lungs.
These tumours often do not cause signs and symptoms until late in the disease but it often releases hormones which causes symptoms like flushing attacks, cough due to airway spasm, diarrhoea etc when it spreads to the liver. There is no effective treatment, though surgical removal /de-bulking of the tumour followed by medications can keep the symptoms under check.
“In the case of this patient, the condition was more complicated as she had developed carcinoid heart disease – the hormones secreted by the tumours in the liver damaged the tricuspid or right valve of the heart, requiring prior Tricuspid valve replacement surgery. Tricuspid valve replacement is a very rarely performed procedure as it is located close to the conducting system of the heart. Without replacing the tricuspid valve, we could not proceed to remove the tumour in the liver, ” said the doctors in the treating team.
The patient thus underwent two major surgeries, the rare Tricuspid valve replacement making way for the safe conduct of the liver and intestinal surgeries to remove the tumours located there, six months later.
The patient recovered smoothly after surgery and the convalescent period was uneventful. As she developed minor cough 5 years later due to residual tumour, a session of radionuclide therapy was undertaken following which the symptoms disappeared .
Ten years later, the patient remains symptom-free and is leading a normal life, much to the delight of the family and the surgeons who performed the complex surgery.
“She is a living example of the dedication and professional competence of the late Dr. Rajashekharan, the cardiac surgeon who took up the challenge of carrying out the rare valve replacement,” said one of the doctors in the team.
The case was presented in the Asia Pacific NET conference with accolades aplenty and published in the Journal of Clinical Gastroenterology and Hepatology.
The Department has come a long way since then and in the past three years, 40 major liver surgeries for various complex conditions were performed by the Department with good results, most of them for State resident patients covered under the government’s KASP insurance .
Even at the height of COVID, around 10 complex liver surgeries were taken up here.
The Department along with its sister specialities is now in the last mile preparations for re-launching its liver transplant programme. A list of potential liver transplant recipients has been drawn up following initial labs and their final workup is being completed on a priority.
