Primary tumors of the diaphragm are rare. Diaphragmatic tumors arise from mesenchymal tissue because of their mesodermal origin, and all varieties of these tumors have been reported. In most instances, these tumors are small and can be excised with a primary repair anticipated. In some cases, en bloc excision of the diaphragm is required, and in many instances diaphragmatic replacement is necessary using a variety of thin plastic prostheses, if a wide resection is required. Attempts at primary repair under tension, especially on the left side, may lead to diaphragmatic rupture and herniation.
A team led by Senior Surgical Oncologist, Dr. Sabyasachi Parida conducted an operation on a young man with a large left sided diaphragmatic tumor on 5th April 2024. It was so huge that he was unable to accept solid food. He had to be put on small multiple liquid feeds to keep him from losing weight.
Latest news Diaphragm is the primary respiratory muscle of the human body that acts like bellows. It separates the chest cavity and lungs from the abdominal cavity and its organs. It is normally described as a right and left diaphragm. It is a constant lifelong work like the heart and hence very important.
The tumor was compressing all adjacent organs like the stomach, colon, left lobe of liver and spleen and was densely adherent to them.
Normally, access to such a tumour requires opening up of both the abdomen and chest. A chest drain is usually required. This causes considerable pain and discomfort for the patient. However, Dr. Parida planned the abdominal incision in such a way that eventually, neither the chest incision nor the chest drain was required. The surgery was challenging and tedious as the tumor was confined between the rigid rib cage and vital and highly vascular organs like liver, spleen, stomach and multiple blood vessels all around.
Careful dissection aided by high end surgical equipment ensured both safety and speed. The entire surgery was completed in 6 hours without any intra-operative destabilization or need for blood transfusion.
The tumor measured around 24x 17 cm and weighed more than 2 kg. Such a large diaphragmatic tumor is rare and challenging to exercise.The large diaphragmatic defect was then reconstructed with a 20x 15 cm polypropylene mesh and overlaid with omentum(fat apron of abdominal cavity). He was extubated on the table and shifted to bed without the need for any intensive care support or respiratory support.
The OT team comprised of Dr. Monika Dabgotra, Consultant Anaesthetist; Mr. Bibhas Prasad Barik,OT Technician; Mrs. Kalpana Ojha, Senior OT Sister; Mikina Pradhan , Senior OT Support staff; Rosina, Rupali, Sasmita Sahani, Sasmita Mallick, Anuradha-Nursing Officers along with Residents and other staff.
KIMS Cancer Center is furnished with dedicated modern modular OTs, equipped with the best and latest equipment available at major cancer centres around the world. This enables the performance of complex surgery with minimal complications. More than a decade of experience in performing complex cancer surgeries and Comprehensive Cancer management facilities have made KIMS Cancer Centre, the preferred choice of Cancer Patients and Caregivers.