The Hindu : Tamil Nadu / Coimbatore News : Cancer affected bone removed to save limb

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Monday, Mar 17, 2008
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Cancer affected bone removed to save limb

Special Correspondent

GETTING BETTER: The doctors involved in the limb sparing surgery watch K. Balasubramaniam’s recovery at Sri Ramakrishna Hospital in Coimbatore on Saturday.

COIMBATORE: A team of cancer specialists and an orthopaedic surgeon at Sri Ramakrishna Institute of Oncology and Research here have salvaged a 30-year-old man’s cancer-affected leg instead of amputating it.

Director of the institute P. Guhan told presspersons on Saturday that this could pave the way for tie-ups with exclusive orthopaedic centres for such surgeries. Orthopaedic surgeons from such centres and cancer surgeons from the institute could team up to save limbs instead of taking the routine approach of amputation.

K. Balasubramanian, a native of Munnar and working as a fitter in an industrial unit in Somanur, was diagnosed with a malignant tumour in the left thigh bone. Dr. Guhan said bone cancers were generally rare and occurred during childhood and adolescence. Bone cancers constituted only two per cent of all cancer cases in the world. And, it was very rare for a person aged 30 to have this problem.

The institute performed three weeks ago the “limb sparing surgery” that was first done at the Adyar Cancer Institute in Chennai in 1988.

Surgical oncologists K. Karthikesh and S. Bhargavi, orthopaedic surgeon G. Balasubramaniam and Dr. Guhan (medical oncologist) were involved in the surgery. “The significance of this surgery is that the patients do not lose their limbs,” Dr. Balasubramaniam said.

Dr. Karthikesh said 18 cm of the bone was affected by cancer. With some margin on either end, the affected portion was removed and replaced with a prosthetic (artificial) bone made of stainless steel. Some soft tissues along the bone were also removed as they might have been affected. Since it was not possible to detect very microscopic problems in these, removal was better.

Dr. Guhan explained that preserving the affected limb had been made possible by the advent of potent chemotherapeutic agents that were usually administered in multi-drug combinations.

The patient went through three sessions of chemotherapy to reduce the size of the tumour in the bone. Meanwhile, an order had been placed for a prosthesis that was custom-made for the patient. The patient was able to walk now and had to undergo three sessions of chemotherapy after the surgery also. The rehabilitation process involved physiotherapy to restore the usual movement of the limb.

“The full movement will not be restored,” Dr. Bhargavi said. “There will be some modification to the use of the limb.” Therefore, the patient would have to undergo vocational rehabilitation at workplace. The surgeons said that the patient should be extremely careful at work and with his movements elsewhere as he could not afford to get injured. A fall could cause damage to the prosthesis.

Dr. Balasubramaniam said bones harvested from cadavers would be the most suitable replacement to a cancer-affected one. Dr. Guhan said bone banks could meet this requirement. But, procedures for this had to be standardised as in North America so that the harvested bones did not carry any infection.

Even though the natural bone was not available now, the stainless steel or titanium prosthesis helped immensely in avoiding amputation.

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