ACOG Member Vaagn Andikyan, MD, a board-certified gynecologic oncologist with the Western Connecticut Health Network (WCHN), and Assistant Professor for the University of Vermont Larner College of Medicine, shares his experience performing a lifesaving surgery on a patient with a 132-pound ovarian tumor in a guest blog post.
When I first saw the patient, she was unable to walk. She had shortness of breath and severe abdominal pain. She was malnourished because what we later learned was a 132-pound ovarian tumor was sitting on her digestive track, making it difficult to hold down food or water.
She sought care when she started to gain about 10-pounds a week. When she was ultimately referred to me, this 38-year-old woman had endured about two months of rapid weight gain. I saw fear in her eyes. I was determined to help her and I knew that I could at Danbury Hospital.
A computed tomography scan revealed a large ovarian mass. I suspected it was a benign mucinous ovarian tumor. The size of the tumor — measuring about three feet in diameter — along with its location made it a life-threatening situation. The tumor occupied the patient’s entire abdomen, and was compressing her aorta and vena cava. I was concerned about an underlining blood clot. The question became how do we remove this tumor and ensure the patient’s safety?
I assembled a team of nearly 25 highly skilled, caring clinical specialists, including fellow ACOG member and gynecologic oncologist Linus T. Chuang, MD, Chairman of Obstetrics and Gynecology for WCHN, plastic surgeon David Goldenberg, MD, Section Chief, Plastic Surgery Subsection at Danbury Hospital, and anesthesiologist Karl Kulikowski, MD, Vice Chairman, Department of Anesthesia, Medical Director, Operating Rooms, Department of Anesthesiology at Danbury Hospital.
Extensive pre-operative planning was crucial because there were many unknowns and hurdles to address. For example, because the tumor was so large, a concern was the amount of excess skin and our ability to close the incision.
We developed and practiced plans for five potential scenarios. Our goal was to perform the tumor resection and abdominal reconstruction at the same time to reduce the number of surgeries for the patient and improve her outcome.
In the end, the surgery took about five hours. We successfully removed the tumor — and only the patient’s left ovary. The patient went home just two weeks later and is expected to make a full recovery.
This was one of the most challenging, complex cases of my career. I might expect to see a 25-pound ovarian tumor, but a 132-pound ovarian tumor is rare. It reminded me how important it is to have colleagues you can rely on and trust. Our ability to pull together our expertise and experience is what gave us the confidence and knowledge-base to tackle this case, especially because this was the first surgery of its kind at Danbury Hospital. Danbury Hospital’s cardiovascular experts were instrumental to ensuring the patient’s safety. Medical residents conducted imperative research to aid in developing the care plan. The operating room staff prepped a room to accommodate a tumor of this magnitude. Dr. Goldenberg removed excess skin that was stretched by the tumor and reconstructed the patient’s abdomen. Danbury Hospital’s Intensive Care Unit and Inpatient Rehabilitation helped the patient to convalesce safely and quickly, and social workers helped the patient and her family to navigate her care plan.
The tumor tissue is currently with WCHN researchers at the Rudy L. Ruggles Biomedical Research Institute. They are conducting genetic tests. We want to understand why the tumor grew so quickly so we and our patient can learn from this case.
This case also reminded me how important it is to participate in community outreach to encourage women to routinely see their primary care providers and gynecologists for wellness screenings.
Thank you for the opportunity to share this extraordinary case with you all.