For the family, the recurrence of cancer after nearly a decade had brought back a familiar sense of fear and uncertainty. The patient had undergone surgery and radiotherapy for endometrial sarcoma 10 years ago and had remained disease-free for a decade.
She recently developed swelling in both legs and blood in her urine, prompting further medical evaluation. Investigations revealed that the cancer had returned in the abdomen and right pelvis. More significantly, advanced imaging showed a massive tumour thrombus extending into the Inferior Vena Cava (IVC)—the major blood vessel that carries blood from the lower part of the body back to the heart.
The unusual extent of the recurrence made the surgical procedure extremely challenging. At Peerless Hospital, Kolkata, the medical team determined that complete surgical resection offered the patient the best possible chance of achieving meaningful disease control.
A multidisciplinary team takes on an extraordinary challenge
Given the complexity of the case, a specialised multidisciplinary team comprising Gynae-Oncology, Surgical Oncology, Gastro-Oncology, Uro-Oncology, Cardiothoracic and Vascular Surgery (CTVS), Anaesthesiology and Critical Care was constituted.
After detailed evaluation and medical optimisation, the patient underwent a complex surgery lasting nearly 10 hours.
A cystoscopy was first performed to confirm that there was no involvement of the urinary bladder. The team then opened the abdomen and proceeded with clearance of the pelvic tumour.
During the extensive tumour clearance, the right ureter sustained an injury. The Uro-Oncology team immediately addressed the complication and successfully re-implanted the ureter.
The Surgical and Gastro-Oncology teams then carefully mobilised the liver to expose the Inferior Vena Cava. The CTVS team created an artificial vascular bypass to temporarily divert blood flow, allowing the IVC to be safely clamped.
The tumour thrombus was meticulously removed, following which the IVC was repaired and re-sutured.
The surgery also involved advanced blood-conservation techniques. A Cell Saver system was used to collect, process and return the patient’s own blood lost during surgery. Remarkably, the entire procedure was completed without requiring a single unit of external donor blood.
Smooth recovery after a high-risk surgery
Despite the complexity and duration of the operation, the patient’s recovery was remarkably smooth. She was extubated on the first postoperative day and gradually resumed oral intake.
The minor post-operative complications were efficiently managed by the team. After a two-week hospital stay, the patient was discharged in a stable condition.
“This was an extraordinarily challenging operation because the recurrent tumour involved the pelvis and abdomen and had extended into the Inferior Vena Cava. Such a procedure requires meticulous planning and close coordination between multiple specialties. The ability to safely remove the tumour thrombus while preserving the patient’s vital blood circulation was a major surgical challenge. The successful outcome demonstrates the importance of a truly multidisciplinary approach in managing complex recurrent cancers,” said Dr. Amit Mandal Consultant Gynae Onco Surgeon, Peerless Hospital, Kolkata.
The case, described by the treating team as a first-of-its-kind surgical achievement in Eastern India, highlights the possibilities of advanced cancer surgery when expertise from multiple disciplines comes together.
The successful combination of complex oncological surgery, vascular reconstruction, urological intervention, anaesthetic management and blood-conservation technology provided the patient with a potentially life-saving treatment option in a situation that would traditionally have been considered extremely high-risk.
For the 55-year-old woman from South Kolkata, what began as the frightening return of a cancer after 10 disease-free years has now become a story of advanced medical expertise, teamwork and renewed hope.
Dr. Amit Mandal
MS (Gynae & Obs), DNB (Gynae & Obs), MCh (Gynaecologic Oncology, AIIMS – New Delhi)
Consultant Gynae Onco Surgeon
Peerless Hospital, Kolkata
Phone +91 99033 64562
Email suchismita@peerlesshospital.com
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