Week 3 Fredrik T

In the passed week I observed a number of procedures and operations.

I saw two abdominal wall reconstructions. A decellularized bovine mesh was used to strengthen the reconstructed abdominal wall. Both patients had had numerous complications from previous operations, including obstructions and radical resections in their gastroenerological anatomy. One patient had an ileal pouch-anal anastomosis. It is very troubling to realize that many patients that have radical procedures have to have procedures done every couple of years and that most chronic conditions cannot be fixed with one single operation.

I also followed Dr Osborne in his clinic. Doing so, I witnessed a couple of hepatic cancer Yttrium-90 radio-embolic therapies. The idea is that instead of giving the patient conventional external beam radiotherapy, the patient is given cancer-targeting radioactive microspheres. The microspheres contain radioactive Yttrium-90 with a relatively short half life. After some initial PET scans using radioactive tracers the total liver volume, tumor volume, lung and gastric shunt can be determined.

This way the patient can get a much higher total dose without significant side effects compared to conventional therapy. The spheres are delivered through a catheter into the subbranch of the hepatic artery that has been shown to supply the tumor with blood in previous angiograms.The spheres preferentially concentrate in the tumor tissue due to the leaky tumor vasculature. From the angiogram images it was easy to see that the tumor vasculature is largely unorganized and in stark contrast to the well defined branching of the healthy part of the liver.

Interestingly one patient had an aberrant anatomy where the liver was supported with an abnormal vessel, allowing for a better targeted therapy, with very limited lung and gastric shunt. It is thus obvious that abnormalities can be beneficial in some cases and that school book anatomy isn't necessarily true for every patient. These elegant targeted therapies highlight a number of points that we often talk about in cancer related discussions, including the aberrant and leaky vasculature of cancer tumors. It is also amazing how few side effects these treatments have, the patients can generally leave the hospital on the same day and do not risk complications to neighboring organs as in conventional therapy.