Tuesday, December 15, 2009

Bad Ass

Ex vivo cancer surgery from Dr Kato at Columbia on a giant liposarcoma invading liver/pancreas/stomach. (NY Times)


Anonymous said...

I was at the surgery for a few hours, at lunch I'll write a bit more

Anonymous said...

Fly on the wall here,

So the first part of the procedure looked to me a lot like a liver ex-plant for transplant. Lots of oozing, frightening pathology, Kato perched on the side of a stool leaning on the patient's chest holding a long-tipped bovie like a paint brush (not exactly the posture they taught me on surgery). Anesthesiology attendings were in the case the entire time looking a tad paler than usual. Kato was by no means the only transplant attending on the case, Emond seemed to float in out whenever the notion stuck him. For some bizzare reason (possibly to give tx surgery a nap) ENT came in for the IJ harvest.

I came into work the next day, after a nice 8 hour med student beauty sleep, and Kato + fellows are now on the back-table meticulously peeling crap off vessels. The un-sung heroes in this are the poor sobs that had to hold retraction with debackeys for untold hours while kato dissected on the backtable. That must have been mind-numbing, or at least hand numbing given the amount of ice on the viscera.

Now a week out from the operation, the dust as settled on that case, and the transplant guys been on a tear, transplants every day. I wonder if these guys even know their way home.

Anonymous said...

Interesting that his first tumor was a benign neurofibroma. At 50, my dad was found to have a football size tumor in his peritoneal cavity. They told us it grew from a nerve ending and they called it a schwannoma-sarcoma. By the time he passed, 11 years later, they called it a liposarcoma. I would like to know more about the history of these types of cancer morphing into liposarcomas if anyone knows.

My dad's remained lower grade, recurring about every 3 years until turning high grade in the end. In the final surgery, they were not able to close him up at all and we brought him home on hospice that way. Not a pretty sight.

He did have one kidney removed, I think during the third surgery at Mayo where they pulled all his organs out so they could radiate his cavity. He did have bowel removed during all 4 surgeries.

I think that first tumor at least, the huge one, was encased, and it was pushing organs, but he had no symptoms, except I suppose a little weight loss, although I don't know if that was intentional or not. He happened to notice a tender spot on his stomach as he was pressing on it wondering why he hadn't lost weight there and thought it was a hernia.

I've had two symetrical dermatofibromas removed from my upper arms that both recurred further up and I sometimes wonder if they could wind up being precursors.

j said...

Fascinating insider info, thanks for posting, anon.

nemsova said...

great posts guys, thx