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Case 2 - Operated a case of Giant retro-peritoneal tumour of about 12Kgs

This is regarding Mr. Venkateshappa UHID no 267766 who is 73yrs old presented with Lump Abdomen and swelling in the neck
On evaluation he was noticed of having large 30*27cm retroperitoneal mass completely encasing the Right Kidney and he was also diagnosed of having papillary carcinoma thyroid.
After the pre operative work up, patient was planned for retroperitoneal tumor excision
Total duration of surgery was 4 hrs
Intraoperatively, tumor was completely encasing the kidney and Inferior venacava. tumor was resected completely, which measures about 12kgs in weight.
Post operatively patient has done well
Pt was operated for papillary Ca thyroid for which he underwent Total thyroidectomy with B/L central compartment and B/L lateral Lymphnode dissection
Post operative period was Uneventful
patient got discharged

Case 3 - A case of Right Renal Cell carcinoma with lung metastasis with IVC thrombus

This is regarding Mr. Ramachandrappa UHID no 306343 who is 48yrs old presented with Abdominal lump in the Right lumbar region
On evaluation in the PET CT scan, he was noticed of having large 12*15*12cm retroperitoneal mass arising from the Right Kidney and extensive tumor thrombus in the Renal vein extending into IVC till infra hepatic region and multiple nodular opacities in the both lungs
In the multidisciplinary tumour board ,the treatment plan was discussed and pt was advised surgical treatment.
Pt was preoperatively optimised and planned for Cytoreductive Nephrectomy with IVC thrombectomy (supra-major surgery)
Total duration of surgery was 5 hrs Intraoperatively, 6 point PRBC and 2 point FFP were transfused
Post operatively patient was doing well

Case 4 - A case of Left Adrenal pheochromocytoma

This is regarding Mrs.Rathnamma UHID no 311008 who is 40yrs old presented with headache ,vomiting , abdominal pain
known HTN since 1 yr on medications
On further evaluation , urine metanephrines – normal
serum metanephrines - normal
MRI abdomen (plain) - well defined T2 hyperintense lesion showing no loss of signal on chemical
shift imaging seen arising from left adrenal gland as described - likely pheochromocytoma
Renal doppler - normal
In the multidisciplinary tumour board , the treatment plan was discussed and pt was advised surgical treatment.
Pt was preoperatively optimised with Tab.prazosin & tab.propranolol as advised by the physician, for a period of two weeks planned for excision of left adrenal tumor
After taking adequate preoperative measures, proceeded with surgery
Total duration of surgery was 3hrs
Intraoperatively, BP fluctuation noted during tumor handling and BP normalised after the tumor removal
Post operatively patient was doing well

Case 7 - Hyperthermic Intraperitoneal Chemotherapy (HIPEC)

The department of surgical oncology On September 9, 2024, a surgical procedure was performed on Poonam Shanmugam, a 57-year-old female with UHID NO 495899, from Tamil Nadu, who was diagnosed with right ovarian cancer in May 2024 at Narayana Hospital, Bengaluru. After undergoing diagnostic laparoscopy and peritoneal biopsy, her condition revealed disseminated deposits across the abdominal wall and viscera, with a Peritoneal Cancer Index (PCI) of 33. She subsequently received three cycles of neoadjuvant chemotherapy (NACT) but faced financial constraints by virtue of which further treatment at Bangalore couldn’t be continued.

The patient was admitted to RLJH and RC under the care of the Surgical Oncology team on September 6, 2024. Following a thorough re-evaluation and multidisciplinary tumor board discussion, it was determined that she would undergo interval cytoreductive surgery with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) on 9th September, 2024. This surgery involves a meticulous approach to remove cancerous tissue and administer heated chemotherapy directly into the abdomen in the same sitting . Using a specialised HIPEC machine which was rented at an affordable price from Bangalore.

The operative team consisted of surgeons Dr. Abhay K, Dr. Abhishek, Dr. Suraga who performed the cytoreductive surgery and HIPEC, which was administered under the supervision of medical oncologist Dr Loknath , using Cisplatin (at 85 mg/sq mm for 90 minutes).

This procedure was supported by the nursing staff, led by Kavitha sister, and the anesthesiology team of Dr. Sujatha and Dr Vidya. Blood Bank team headed by Dr. Subhashish Das, played a critical role by aiding in arrangement of O -negative blood for the patient’s intraoperative transfusion, which included two units of packed red blood cells (PRBC), two units of fresh frozen plasma (FFP), and one unit of albumin.

Post-surgery, the patient was transferred to the ICU, where she was placed on elective ventilation. The ICU team, under the leadership of Dr. Suresh, closely monitored her progress. She was extubated the following day and placed on CPAP for one day before being moved out of the ICU to the ward. Currently the patient is doing well and is being planned for discharge.

Case 8 - Rare Case of Retropancreatic Ganglio-Neuroma

SURGICAL ONCOLOGIST: Dr.Ashwathappa, Dr.Abhay Khattepur,

RESIDENTS :Dr.Pradeep B,Dr. Abrar Ahmed,Dr.Pradyumna SR,Dr Vivek Hariharan

Anaesthesia team: Dr. Vishnu Vardhan, Dr Gagan, Dr Dinesh

OT nurse: Sujatha

Date of operation: 05-11-2024

This is regarding 39 years old female patient Mrs Manjula was referred to Department of Surgical oncology from private hospital for unresectable retropancreatic soft tissue tumour. Patient presented with pain abdomen since 1 month. On evaluation she had a 8 X 6cms ill-defined mass posterior to pancreas abutting the SMV and in close proximity to spleen, left kidney and adrenal, SMA and celiac axis and she was suspected to have a retroperitoneal lymphoma / Retro pancreatic soft tissue tumour. And was deemed to be inoperable due to close proximity to major vessels.

Patient under went USG GUIDED biosy which was suggestive of Rare Ganglioneuroma .Case was Discussed in Tumour Board and was planned for surgery.After the pre operative work up, patient was planned for retroperitoneal tumor biopsy . Patient underwent surgery on 4/11/24Total duration of surgery was 6 hrs. Intraoperatively, tumor was abutting the SMV and in close proximity to spleen, left kidney and adrenal, SMA and celiac axis. Tumor was successfully resected in toto preserving all the above mentioned structures. Patient had an abnormal anatomy with aberrant direct common hepatic artery arising directly from abdominal aorta. Post operatively patient Improved. Drain was removed on POD-7 and was discharged on pod-8.Post operative HPR consistent with Ganglioneuroma.

Case 9 - HCC

SURGICAL ONCOLOGIST: Dr Aswathappa D , Dr Abhay K

Hepatobiliary Surgeons: Dr Rajiv Lochan , Dr Aravind (Manipal Hospital Bangalore)

Residents : Dr Pradyumna SR , Dr Abrar Ahmed, Dr Vivek H

Anesthesia Team : Dr Vishnu Vardhan , Dr Bharath

OT Nurse : S/N Chitra , Sujatha

Date Of Surgery – 18/11/2024

This is regarding a 37 year old female patient Mrs Munirathna UHID No- 390257, who was evaluated for upper abdominal mass. On examination she had gross hepatomegaly with right hypochondriac mass 19.8 x 15.2 x 14.3cm abutting segments V C VI of right lobe and caudate lobe of liver . displacing the right hepatic vein , portal vein and gall bladder anteriorly . medially displacing IVC , duodenum and head of pancreas. Right kidney pushed inferomedially to lie in the midline . Provisional diagnosis of Fibrolamellar HCC / multifocal angiomyolipoma was made.

Case was discussed in multidisciplinary tumor board and planned for surgery . Patient underwent surgery on 18/11/2024. Total duration of surgery was 10 hours. Intraoperatively – a large mass 20x 25 cm arising from the liver , displacing adjacent bowel , stomach C right kidney . Mass was infiltrating segments V, VI, VII of the liver . There after an extended right hepatectomy along with the successful resection of tumor was performed, preserving all vital structures . Post operatively patient improved symptomatically . Patient was discharged on POD 12 .

Case 10 - Giant Cell Tumor (GCT)

On February 3, 2025, the surgical oncology and orthopedic teams at RLJH & RC successfully performed right distal femur en bloc resection with megaprosthesis for Ms. Lakshmi (UHID: 537995), a 21-year-old woman diagnosed with Giant Cell Tumor (GCT) of the right distal femur.

The patient, who had recently delivered a baby and was caring for her one-month- old child, required early surgical intervention to preserve her mobility and improve her quality of life. However, due to financial constraints, assistance was sought to cover the cost of the megaprosthesis, which was essential for the procedure.

Through the collective efforts of the hospital management, faculty, and donors, the required financial support was arranged as follows:

• ₹50,000 was provided by the hospital management.

• ₹30,000 was contributed by faculty and other donors.

• The remaining amount was borne by the patient’s family.

The surgery was successfully performed by a multidisciplinary team, including Dr. Arun (Professor, Orthopedics), Dr Aswathappa ,Dr. Abhay, Dr Lavanya (anaesthesia) and the surgical oncology team. The patient is currently under post-operative care and recovering well.

Case 11 - Right Hepatectomy for Liver Tumor

On January 29, 2025, surgical oncology team at RLJH and RC successfully managed a complex case of a massive liver tumor in a 68-year-old man, D. Venkateshappa (UHID: 555284).

The patient was diagnosed with Hepatocellular Carcinoma (HCC) and presented with a large tumor involving the complete right lobe and caudate lobe of liver significantly affecting liver function, with only 30% of functional liver residual. After a thorough evaluation, the team planned a right hepatectomy to remove the tumor while preserving essential structures.

During an extensive 12-hour surgical procedure, the team performed a right hepatectomy, ensuring meticulous resection of the tumor. The surgical team, led by Dr. Aswathappa D and Dr. Abhay K, was supported by Dr. Praveen liver transplant surgeon, along with residents and anesthesiologists Dr Ravi, Dr Anushree .

Following surgery, the patient’s recovery has been closely monitored. He is now recovering well under regular follow-up care