The future looked grim for Amira Baboolal.
With four tumours growing near critical parts of her liver, it would have been risky performing another open surgery in under two years.
But within 24 hours after the 61-year-old cancer warrior was wheeled into the theatre at the Southern Medical Clinic in San Fernando on Monday, she was on her way home with the tumours burned dead.
The Mt Lambert resident was the first patient in the English-speaking Caribbean to undergo a microwave ablation of colorectal metastases using revolutionary equipment called the Emprint Ablation System that destroys the tumours.
For the first time, the technology which was developed by international medical equipment developer, Medtronic was used in T&T.
Prof Shamir Cawich, who specialises in liver and pancreatic surgery, said that not only will patients have a shorter recovery period, it will significantly increase their five-year relative survival rate.
The Belize native, who lectures at the University of the West Indies, said that the procedure can also be used to kill tumours in the kidney and lungs that are within five centimetres in diameter. Based on the location of the tumours in the organs, it can either be done through open surgery or laparoscopy.
In 2017, Baboolal had surgery to remove tumours from her colon. But earlier this year, she returned to the Port-of-Spain General Hospital (POSGH) for problems with gallstones. During one of her visits, she was instructed to have a blood analysis and following an MRI and CT Scan, it was found that she had four tumours in her liver. What made her situation even more damning was that part of her liver had already been removed.
“With this (procedure) it is a much safer way and chances of healing is quicker because it is not cutting and that type of thing. So I figure it is safer than doing the traditional way, on top of which, I don’t think they can because I don’t have a whole liver.
“I had cancer surgery done in 2017 for my colon and it metastasized 18 months after that surgery. But that surgery was still successful; I don’t have cancer there again. It was really surprising to hear that it went somewhere else. It is always a frightening thing to have surgery, but there was always a chance,” Baboolal said.
Baboolal’s procedure was an open surgery because her tumours were very close to very critical structures that if damaged, could have caused significant problems. Although she was nervous before the surgery, she joked that as the first patient for the procedure, she was a bit of a celebrity. However, she relished the opportunity to have a surgery that would last up to an hour as opposed to the eight hours it would take using traditional methods.
Her surgery was followed by another patient who underwent a microwave ablation of neuroendocrine liver metastases. Both patients were from the POSGH and were done pro-bono by the surgeon and hospital.
Medical sources said liver surgery can cost up to $200,000 privately as it would include a possible three-day stay in an intensive care unit and up to two weeks stay at the institution.
Cawich said that both patients were expected to be discharged on Monday as the procedure only required him to make an incision that was mere millimetres in diameter.
“I think this is a very good option for patients who have tumours in their liver. It can also be done for tumours in the kidney, for tumours in the lungs but this now adds a whole new tool for these patients, which previously was not available. As you can see which such good survival rates, a low complication profile, this is something that will benefit the population significantly,” Cawich said.
Even with the best chemotherapy available, Cawich said that the accepted five-year survival rate was between eight and 10 per cent, but with the entire tumour being killed, he said this increases significantly.
“Once cancer has spread outside of the colon to the liver, the survival rate, if you do nothing, is about a one per cent chance that you will live up to five years. With the best chemotherapy you have available, the chance is anywhere between five and eight per cent, maybe up to a 10 per cent chance that you will live to five years. With microwave ablation, you can increase that to anywhere between a 30-40 per cent chance so you can see there it is chalk and cheese. Obviously, the best is still surgery. Surgery will give you up to 45 per cent, five-year survival and a chance to survive up to 10 years, which is about 20 per cent. But it again comes at the risk of significant complications.”
How it works
Medtronic product specialist Victor Lizardi explained that a percutaneous antenna which acts as a rod is hooked up to a generator that emits microwaves. Also attached is a tube used to pump a cooling liquid to regulate the heat of the needle that will be inserted into the cancerous organ. Just like meat burns in a microwave, the tumour is killed in the organ. The body then absorbs the dead cells, passes it out and regenerates tissue. Cawich said the liver has the capacity to regenerate and after a year, about 90 per cent of the removed tissue would be replaced. The equipment is being distributed by Bryden Pi. Specialist representative Nichelle Sookdeo said that while Southern Medical Clinic is its only client, the service is in its trial phase in T&T and will hopefully soon be marketed to the public health system.
- by Kevon Felmine. Photo by Rishi Ragoonath.