He removed part of lung for nothing
14-12-2009, 08:17 AM
By Hedy Khoo
A TISSUE sample report showed the cysts in his lung were not
cancerous. But it wasn't relief or elation that this patient
felt.
What should have been good news left Mr Muhammad Jafri, 53,
confused instead.
This was because a small part of his left lung had already been
surgically removed before the detailed results of the test was
available.
He is now wondering if the surgery was for nothing. Was it a
mistake?
He had been referred to a cardiothoracic surgeon at the National
Heart Centre Singapore (NHCS) after a CT scan on his pancreas in
May 2007.
This had revealed cysts in his lungs.
He agreed to have a tissue sample removed for investigation
(biopsy). He now claims he had not given his consent for any other
procedures or for the surgeon to remove any part of his lung.
A spokesman for NHCS, however, said: "The cardiothoracic surgeon
had in fact met the patient prior to the procedure and explained
the nature of the biopsy, and specifically informed the patient
that if there is a positive finding of lung cancer, there would be
a need to remove part of the lung."
Mr Jafri claimed he understood that nothing else would be done
until "the full histology (study of the structure of tissue)
results... were obtained, which usually takes two weeks."
He is now claiming he did not give consent to the removal of part
of his lung.
The biopsy was done under general anaesthesia on 18 Jun 2007 at the
Singapore General Hospital (SGH).
The next day, Mr Jafri said the surgeon informed him that during
the surgery, the cysts were found to be cancerous. The surgeon had
then removed the affected upper left lung.
Shocked but grateful
"I was shocked to hear I had cancer, but felt grateful to the
doctor for saving my life," he said.
However, a few days later, the final report from the biopsy showed
that the cysts were not malignant.
He learnt that during the surgery for the biopsy, a tissue sample
was also sent for a procedure called frozen section.
This can give a provisional diagnosis during the surgery itself to
determine if cancer is present. Based on this provisional
diagnosis, surgeons will decide on the next course of action.
Mr Jafri's tissue sample sent for frozen section had been reported
to be cancerous.
Based on this, his surgeon had decided to remove the affected part
of his lung.
The NHCS spokesman explained that there are valid and important
reasons a surgeon may need to perform surgery in the same
anaesthetic setting based on frozen section results rather than
wait for the formal histology report from the biopsy.
"Very often and especially in cancer cases, deferring surgery to be
done on a subsequent occasion can jeopardise sterility, and
subsequent surgery may also become more technically difficult at
the site of where previous surgery was performed," said the
spokesman.
"There are conditions where the cells are highly reactive and can
closely mimic cancer cells and the true nature of the diagnosis may
only be clarified with the availability of formal histology
results.
"Hence, this case is not a case of an actual error in diagnosis,
but rather it demonstrates that there are inherent limitations with
certain investigations."
The spokesman added that when the surgeon believes a cancerous
tumour has been found, it may become important to conduct immediate
surgical excision to minimise the risk of cancer cells from the
biopsy site spreading to other areas.
The NHCS spokesman said that Mr Jafri retains about 75 per cent of
normal lung function after the operation.
"This should not affect most normal daily activities to any
significant extent."
Followed rules
In a joint reply, NHCS and SGH explained that the biopsy and frozen
section had been done in accordance with well-established
practice.
A spokesman for NHCS and SGH said the published accuracy rates for
intra-operative frozen sections range between 85 per cent and 98
per cent.
"Despite the inherent risk of false positive or false negative
diagnosis associated with frozen section, they are nevertheless an
important diagnostic tool in that they provide the surgeon with an
'on table' diagnosis in cases where a decision on surgical
intervention may have to be made within the same surgical setting,"
she added.
"When the formal histology report eventually established that there
was no malignancy in the lung lesion, the finding was readily made
known to the patient on the very day itself."
The spokesman said Mr Jafri should not require medication all his
life but he does have many pre-existing medical conditions
unrelated to the removal of a part of his lung.
The recovery period varies but would range from one to three
months.
She added that he will have to continue regular check-ups to
monitor the growth of the pancreatic tumour as well as his other
medical complaints.
Mr Jafri is now claiming that even if he had cancer, he would have
sought alternatives to surgery.
He said he spent almost a month recuperating in the hospital and
gets breathless easily now. He had previously undergone five
operations on his spinal cord.
Mr Jafri said he had only enough money to hire a lawyer to write to
the Singapore Medical Council (SMC) to complain about the
matter.
The SMC declined to comment on the case. But according to its
written reply, dated 5 Nov, to Mr Jafri's lawyer, the Complaints
Committee decided that no formal inquiry was necessary.
It said there was no evidence of professional misconduct by the
doctor in charge of reporting the pathological specimens, but noted
that the doctor could have taken greater care to report the degree
of certainty in his diagnosis.
What was done is the accepted treatment for early stage lung
cancer, and the surgeon had acted upon the diagnosis provided by
the pathologist, it added.
It also noted that the surgeon could have taken greater care in the
way he explained and took consent for the procedure.
Both doctors were issued letters of advice from the committee
reminding them to be more prudent in future.
Mr Jafri is not satisfied with the response and has lodged an
appeal with the Ministry of Health. He is waiting for a
reply.
Mr Jafri said: "I lost my job as a lab technician in April this
year. After the operation, I am always having to take medical
leave."
Doc: It is the standard form of treatment
WHEN lung cancer is suspected, a biopsy and a frozen section in
view of a lobectomy (removal of a part of the lung) is a standard
form of treatment, said a cardiothoracic surgeon in private
practice with 20 years of experience.
Should the frozen section indicate that cancer is present, the
surgeon will usually do the lobectomy.
The surgeon, who declined to be named, said the procedures and
course of action to be taken during the operation are usually
explained to the patient to seek his prior consent as he will be
under general anaesthesia during the surgery.
"Most patients will agree to have a frozen section with the view of
proceeding to a lobectomy," said the cardiothoracic surgeon.
He said there are patients who choose not to have any lobectomy
performed based on the frozen section diagnosis, but this is rare.
They prefer to wait for the full histology report.
Lawyer Adrian Wee, from Characterist LLC, said it is necessary to
ask if a pathologist and surgeon had acted in accordance with the
standard line of treatment.
If so, negligence is unlikely.
Source:
http://health.asiaone.com/Health/News/Story/A1Story20091212-185491.html
