Young medical student from Nigeria succesfully treated for complex case

Bengaluru: Gleneagles BGS Hospital recently undertook one of its most complex cases, performing a radical scapulectomy with synchronous radiotherapy and reconstruction using thigh flap on a 22-year-old medical student from Nigeria. The patient, previously treated for chondrosarcoma of the scapula, faced a recurrence of the cancer in the same area, presenting a significant surgical and clinical challenge, especially due to her requirement to avoid blood transfusions as a Jehovah’s Witness.

The young lady initially presented with a six-month history of a growing, painful swelling on her right upper back, limiting her shoulder mobility. Imaging confirmed the recurrence of chondrosarcoma involving the entire scapula with significant bone destruction, though neurovascular structures remained unaffected. This complex case demanded a coordinated approach involving advanced oncology, radiation, and reconstructive surgery.

Lead Surgical Oncologist, Dr Karthik K Prasad led the surgical procedure, noting the meticulous planning required. “Radical scapulectomy is rarely performed, and in this case, the tumor weighed around 1.5 kg. The surgery involved extensive thorough dissection minimizing blood loss, ensuring complete tumor removal verified by frozen section analysis,” Dr Prasad stated. The patient was shifted to the radiation for electron beam therapy. Post-radiation, she was taken back to the theater, where reconstruction was performed.

The team faced an added layer of complexity due to the patient’s faith as a Jehovah’s Witness, which prohibits blood transfusions. The surgical team managed the extensive procedure, which lasted over 14 hours, with a total blood loss of only 500 mladded Dr Prasad. “Close collaboration and careful planning were key to meeting this challenge without compromising her health or surgical outcome.”

The Consultant Anesthesiologists, Dr Ashish Shetty and Dr Purneema were very instrumental in maintaining hypotensive anesthesia throughout surgery thereby minimizing the blood loss and also managed the patient in transit and inside the radiotherapy room. “Post-surgery, patients hemoglobin level was maintained. We managed with iron injections, strictly avoiding any blood products,” added Dr Shetty.

Consultant Radiation Oncologist said “Administering synchronous radiotherapy in such a case significantly lowers the risk of recurrence by delivering targeted radiation directly to the surgical site. This approach was essential considering the aggressive nature of the tumor. I’m glad our combined efforts could provide the patient with a higher chance of a cancer-free future.” Radiotherapy also helped in reducing the oozing of the blood from the surgical site and hence reduced the blood loss.

The Consultant Plastic Surgeon, Dr Naveen Kumar H R said, “Reconstructing such a large defect required precision in creating a 40 cm x 25 cm free flap, which was essential for both the cosmetic and functional outcome. The vascular anastomosis had to be perfect to maintain blood flow in the transferred tissue, especially given the patient’s restrictions on blood transfusion. I am pleased to see the patient recover so well, with shoulder mobility and a positive outlook on her future.”

The surgery resulted in a complete resection of the tumor, and the successful reconstruction allowed the patient to regain function and mobility in her shoulder. Following a smooth recovery, she has resumed daily activities and looks forward to continuing her medical studies. The patient expressed her gratitude, saying, “I am incredibly thankful to the entire team at Gleneagles BGS Hospital for their expertise and dedication. Their ability to meet my unique needs made it possible for me to look forward to a future full of possibilities.”