World Class

This is what can happen when a private practice surgeon refers a complicated colon cancer patient to a medical oncologist affiliated with a certain multinational, gigantic world-famous non-profit health care system.Let's say the surgeon is asked to see a patient with a large bowel obstruction. Perhaps the colonoscopy demonstrated a high grade constricting lesion in the distal sigmoid/upper rectum and the CT scan revealed a massive, locally infiltrating mass invading into the bladder and a possible liver lesion. Perhaps the patient has lost 30 lbs recently and has noted foul smelling material in her urine. The surgeon is concerned about diffuse tenderness on exam, possibly due to impending cecal ischemia. He books the case for the OR and curbsides a med oncologist on treatment options. Should I just divert? Would there be a role for neoadjuvant chemoradiation? Or best to just try and resect now with possible pelvic exenteration? The med onc guy isn't too certain. Whether there is liver involvement or carcinomatosis is key. But no time to determine that now given presence of an acute abdomen. He thinks the case ought to be presented to the tumor board and perhaps a multidisciplinarian consensus could emerge. The surgeon thinks this seems reasonable. He performs a laparoscopic diverting colostomy and places a mediport. CT guided liver biopsy is scheduled as an outpatient. She recovers from the surger...
Source: Buckeye Surgeon - Category: Surgery Authors: Source Type: blogs