Brazilian surgeons based in the US face inoperable cases – Health

Patients considered inoperable by renowned surgeons in the country have managed to undergo procedures that challenge the limits of medicine without having to travel abroad. A couple of doctors from Curitiba who work at the Miami Transplant Institute (MTI), from the University of Miami, has come to Brazil to serve clients who are able to pay for operations that expand the concept of high complexity.

The doctor Rodrigo Vianna lives in United States for two decades and runs the MTI, the largest transplant center from the country. Specializing in the abdomen, he has in his team his colleague Tiago Machuca, known for being one of the best chest surgeons in the USA. Both have entered into a partnership with Rede D’Or and are called whenever an almost impossible case arises in one of the company’s elite hospitals.

In everyday medicine, many people who could benefit from the extraction of a cancer end up not being operated on because of the surgical risk. This occurs when the tumor is located in an area that is difficult to access or invades a major blood vessel, which carries a risk of bleeding and death during the procedure. In these situations, Vianna and Machuca’s expertise is required.

“What we do can be called ultra-complexity surgery, a mixture of transplantation and cancer surgery”, says Vianna. “It is the union of two specialties because it is necessary to remove organs, extract the tumor and perform anastomosis (rewiring) of vases.” It is a type of operation that requires excellent vascular and oncological training from the physician. “As it’s practically a new specialty, it’s very difficult to find professionals with experience in both,” he says.

autotransplant

In the US, the MTI team is known for performing autotransplants in cancer patients. When the case is deemed inoperable because of the surgical risk, doctors extract the affected organs. They are cooled and placed in a preservation solution. The tumor is removed from the body or the extracted organs and returned to the patient.

Two months ago, businessman Washington Ney Barbosa, 65, owner of a women’s footwear brand, entered the surgical center at Hospital Vila Nova Star, in São Paulo, to try to eliminate a 5-centimeter tumor that had grown inside the vein. superior mesenteric artery, responsible for draining blood from the intestine. Vianna explained that perhaps the autotransplant was inevitable.

Diagnosed 15 years ago with neuroendocrine pancreatic cancer (the same one that killed businessman Steve Jobs), Barbosa had removed several organs in previous abdominal surgeries (pancreas, spleen, gallbladder, duodenum, part of the stomach and intestine). After being deemed inoperable, he decided to try the procedure proposed by Vianna.

“I had no one else to turn to in São Paulo”, says the businessman. “The surgeon spent hours digging into my abdomen, doing everything he could to extract the tumor from the vein without having to remove the intestine”, says Barbosa. “Fortunately, he made it and my recovery was great.” A week later, the businessman was discharged.

He and the surgeon do not reveal the price of the surgery, but Barbosa says he spent around R$200,000 just to pay for the hospital part. According to the doctor, an ultra-complex surgery, with autotransplantation, costs between US$ 300 and US$ 500 thousand in the United States.

Lung

In Rio, doctor Tiago Machuca, a professor of surgery at the University of Miami, faced another inoperable case: that of patient Alcyette Cristina Garcia Piedade, 62, at the Copa Star Hospital. A doctor and former smoker, she began to suffer, in 2017, from severe emphysema.

After undergoing surgeries and complications, she almost had to be put on the transplant list. In November last year, a nodule appeared in the right lung that no professional dared to assess. “I needed a biopsy to find out if she had cancer, but nobody wanted to stick a needle into a scarred lung because that would be too risky,” says Alcyette.

The doctor sought out specialists and the solution presented was to undergo radiotherapy to try to fight a tumor that no one knew was malignant. Instead, she sought out Machuca, who had flown in from Miami to see her in Rio. “I always asked the doctors if my case was the worst they had ever seen. When he said he had operated on more complicated cases than mine, I felt welcomed,” she says.

The surgery was performed at the end of March. Machuca removed about 40% of the upper lobes of the lung and also the suspicious nodule. Three months later, the volume of the organ returned to normal. There was also a 30% improvement in lung function. “She stopped having a severe functional limitation to achieve a quality of life close to normal”, says Machuca.

difficult surgery

  • Challenge: in 2021, a tumor in the superior mesenteric vein, responsible for draining blood from the intestine, started to obstruct blood circulation.
  • Procedure: the removal of this difficult-to-access cancer took more than 4 hours. The tumor was 5 centimeters.
  • Result: two months after the procedure, the patient no longer has the disease.

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