Dr. Aditya Manke: Team work and planning; the two pillars to triumph
On World Cancer Day 2019, we at Medikabazaar have decided to bring you, real and personal stories of doctors who have pushed the boundaries and tackled complex, and complicated medical cases of patients without hopes of any recovery. We want to thank them for their invaluable service to our country!
“Being a surgical oncologist, I have been used to take charge of challenging and difficult cases,” said veteran advanced laparoscopic and cancer surgeon, Dr. Aditya Manke. A Grant Medical College graduate with vast medical experience in Europe, Dr. Manke, while talking to Medikabazaar on World Cancer Day said that in his “surgical oncology practice of last 10 years,” there were many “interesting” cases. However, there was one case which he chose to share in detail.
The case comprised of a 65-year old smoker with a history of COPD (Chronic Obstructive Pulmonary Disease) who came “with an anterior mediastinal mass, which, on the scan was showing suspected infiltration of the ascending aorta and the pericardial wall of the heart,” as elaborated by Dr. Manke.
He continued, “A fine needle aspiration cytology was done which showed thymic carcinoma. We planned for chemotherapy after which he showed some response and then underwent definitive chemoradiation. Despite all the above treatment a PET scan showed some residual disease in the thymus measuring around 3 by 4 cms in size which was free from the major vessels of the heart.”
He added that surgery was the only “option for this gentleman.” However, Dr. Manke noted that a conventional midline sternotomy would not work as the patient’s sternum had gone through radiation which would result in the “non-healing of his surgical wound.” Also, the patient might not be able to survive the surgery due to his COPD.
Dr. Manke said, “He [patient] saw many surgeons for a second opinion who just wrote him off.”
“My team and I gave him the option of Video-assisted Thoracoscopic assisted removal of the tumor to which he agreed. He underwent a surgery where the tumor was removed through a small incision made over the chest wall,” he continued.
Describing the “biggest challenge” of the procedure, Dr. Manke said, “We could not use any lung ventilation for him due to his COPD status, and the whole surgery was performed by compressing his lungs by Carbon dioxide gas insufflation. Further, there was an area of infiltration over the pericardial wall which was also removed successfully.”
Post-surgery, the patient was discharged after two days “without any complications.”
Before such challenging cases, Dr. Manke stated that the majority of his focus goes on the patient’s medical history and imaging.
He said, “Imaging review is a must, and I sit with my radiologist to assess the resectability of the tumor and need of removal of any other organs if required.”
“Meticulous planning is a must to get good surgical results, and before any case, I always have a plan of surgical steps ready beforehand,” he added.
However, regardless of a surgeon’s expertise, complex oncology procedures are not a one-man show.
Echoing the same, Dr. Manke said, “Teamwork is also of utmost importance during such challenging cases, and if required, I always involve the expertise of other specialty surgeons like plastic and microvascular surgeons for reconstruction of defects or major vessels.”