Case Description :
A 60-year-old gentleman diagnosed with a synchronous distal sigmoid colon and lower rectal cancer associated with triple vessel disease presented to us in extreme distress with a 12 cm anal proliferative growth extending to gluteal regions because of which he was not able to sit and 20 kg recent weight loss. He had received neoadjuvant chemoradiotherapy almost a year back, and still radiologically he was a surgical candidate. He was deemed unfit outside and was in severe distress as he was not able to sit due to large growth and continuous bleeding.
Entire family was feeling helpless and mentally patient had given up.
Consultation & Diagnosis
Prompt and accurate diagnosis made in-house
Tumor Board
A multi-disciplinary team deliberated on action
Individualized Care
Patient’s mental makeup taken into consideration
.Counselling of entire family with patient as a centre give priority
Modular Care
A suite of therapies that contribute to holistic healing.
What We Did :
We conducted a multidisciplinary meeting with the cardiologist. After discussion, we decided to address the cardiac morbidity first which was a hindrance to our oncology treatment rather than treating oncology part first under high cardiac risk. We planned Angiography with angioplasty, and after a month, surgical resection with plastic reconstruction.
After angioplasty, the patient was on full anticoagulation medicine for which he required intermittent ICU admission due to bleeding from the anal growth. Finally, after one month, we optimised the patient and operated on dual antiplatelet agent and cardiac risk was taken care of. He underwent Extralevator Abdomino perineal resection with large gluteal muscle excision with plastic reconstruction (TRAM flap)
Action Plan
- Multi-disciplinary meeting
- Addressing Cardiac risk factor first
- Optimised patient’s condition & Psychosocial Counselling
- Performed planned surgery
Final Results :
He recovered well postoperatively and gained 10 kg in the next 6 months. He completed adjuvant chemotherapy. It has been 3 years since and he’s doing his agriculture work at his native place. This is a case of a personalised approach to the patient’s condition, which created a life-changing experience. Skill with the right attitude can give excellent outcomes.
Personalised teamwork can change outcomes.
