Mid-op radiology helps Christie surgeons save man’s life

Press release posted 08 August 2017

A cancer patient at The Christie in Manchester has had pioneering mid-operation radiology to make sure surgeons reached all the disease.

Colin O’Brien’s stage 3 melanoma (the most serious form of skin cancer) was in such a hard to reach place in his neck and armpit that two surgeons had to operate simultaneously from two different entry points before taking the extremely rare step of halting the operation temporarily to bring in a radiologist - a doctor who interprets diagnostic images such as X-rays, MRI and CT scans.

Consultant plastic surgeon Damir Kosutic and specialty plastic surgery doctor Kantappa Gajanan began operating on Colin, 35, in the highly intricate procedure, before consultant radiologist Damian Mullan came in halfway through. Once Dr Mullan conducted an ultrasound and was happy all the cancer had been removed, the surgeons continued with the six-hour life-saving operation.

Mr Kosutic said: “It’s very difficult, almost impossible, to remove the disease from the area between the armpit and neck because of the proximity to the lung and major nerves which can result in paralysis, and it’s easy to cause a fatal bleed. Behind the clavicle is not easily accessible. This is where we needed our radiologist to guide us.

“Mr Gajanan did the armpit, I did the neck and we met in the middle. We asked the radiologist when everything was open, to come into the theatre with his radiology machine and see that the disease, which he marked before the operation, had gone. Using ultrasound in the middle of surgery for a melanoma is something I haven’t ever seen before.

Colin, from Bromley Cross, Bolton, had a tennis ball-sized lump in his armpit that appeared in the new year, several months after an initial operation at another hospital to remove a melanoma from his back following concerns about a mole.

After going back to his GP about the lump he was eventually referred to The Christie and Mr Kosutic organised a scan which revealed Colin had stage 3 melanoma in his neck and armpit.

Without swift intervention his condition would have quickly become incurable. Colin’s groundbreaking operation took place in early March.

“I owe The Christie my life,” said Colin, a business process manager for a medical devices company, whose wife Jessica works for the NHS. “If it wasn’t for the surgeons there, I wouldn’t be alive.”

Mr Kosutic explained: “Colin had a primary tumour on his back. This was removed in Bolton in June 2016 but it spread to his neck and armpit. The disease was also behind the clavicle (collarbone) where major nerves and blood vessels are.

“Colin was young and fit and we thought we should do the maximum radical treatment. I’ve not heard of anyone doing both parts of this operation – neck dissection and axillary (armpit) clearance - alongside ultrasound and without breaking the collarbone.

“There are only four published cases similar to this and in all of these cases the surgeons had to divide the collarbone, which carries a higher risk of death.

“I am very happy with how the operation went.”

Mr Gajanan added: “This was a very difficult operation but it was very successful and I’m pleased to say we have had a good outcome.”

And consultant radiologist Dr Mullan said: “It has historically been unusual for a radiologist to participate alongside a surgeon in complex surgical cases. We have worked closely with Mr Kosutic when imaging patients prior to surgery, and together, have pioneered vascular mapping techniques based upon his expertise.

“Being asked to attend an operation was a further evolution of this multi-disciplinary care.

“In this case, being able to perform ‘hands-on’ imaging during surgery helped us to be immediately confident that the surgery had identified and removed all of the lymph nodes that were involved.

I hope these collaborative approaches will benefit more patients in the future.”

Colin underwent radiotherapy post-surgery and following scans received the all clear. He said: “I would advise anyone with any suspicions about moles to get them checked out. It really is worth it. Although it was risky, without the treatment I had at The Christie I quite possibly wouldn’t be here now.

“After this happened to me half my colleagues decided to get themselves checked out and one other person has found they needed treatment.”

The Christie NHS Foundation Trust has been ranked ‘Outstanding’ by the health regulator the Care Quality Commission which referred to it as ‘exceptional’ and ‘a leader in its field’. It not only commended the Trust for its effectiveness and care, but highlighted its work in shaping the future of cancer care and noted the reach and influence of its clinical research projects. The CQC has also rated The Christie the best specialist trust in the country, and one of the top three trusts overall in England

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