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Bon Secours Cancer Institute Surgeons Perform Rare Lifesaving Surgery

23-year old patient undiagnosed for 11 years; visit to St. Mary’s ER results in path to recovery

Aug. 26, 2013 – Twenty-three-year old Kevon Peoples is back at college and poised to graduate, just months after a surgical team from the Bon Secours Cancer Institute reversed his fatal prognosis from a rare cancer.

The Bon Secours surgical team, with support from some 20 surgical oncology and cardiac nurses and technicians, performed the surgery over a two-day period, successfully removing a cancerous pheochromocytoma tumor, the size of a small football. What made Peoples’ case so unusual was that his condition went undiagnosed for 11 years, while symptoms of rapid heart rate and high blood pressure were dismissed as a hereditary condition, further induced by stress.

By the time Peoples arrived at Bon Secours, his condition had reached a critical stage. “It took the attentive work of Dr. Ngo [a Bon Secours cardiologist on call] in the ER to recognize the situation and ask the right questions,” said Itzhak Avital, M.D., director of the Bon Secours Cancer Institute and a surgical oncologist. “Ngo did the proper work up, or set of tests, which led to the proper diagnosis.”

Peoples’ tumor originated in his adrenal gland, eventually engulfing his inferior vena cava (IVC), the large vein that carries de-oxygenated blood from the lower half of the body into the right atrium of his heart. The tumor then entered the right atrium of the heart, and rested on the right kidney. The cancer metastasized to the liver where doctors identified three additional tumors. P

eoples’ diagnosis was confirmed through a second opinion came from Karel Pacak, M.D., Ph.D, a senior investigator and head of section on Medical Neuroendocrinology at the National Institutes of Health in Bethesda, MD, who quickly referred him to Itzhak Avital, M.D., director of the Bon Secours Cancer Institute and a surgical oncologist, and Alexander Stojadinovic, M.D., a surgical oncologist with Bon Secours Cancer Institute.

"Dr. Avital has exceptionally gifted hands blended with a brilliant mind and decision-making process to perform the most complicated and challenging surgical procedures," said Dr. Karel Pacak, senior investigator and head of Section on Medical Neuroendocrinology at the National Institutes of Health. "He was a natural and by far the top choice for Kevon."

“When we saw Kevon, he was actively dying. He was in liver failure, and the tumor was slowly suffocating his heart; his prognosis was dire. We assembled the best multidisciplinary team possible in Virginia, with the goal of keeping Kevon alive,” said Itzhak Avital, M.D., surgical oncologist and director of the Bon Secours Cancer Institute. “We are fortunate to have the caliber of expertise necessary to take on this kind of case. Our oncology team is assembled from the nation’s best; Dr. Katz is a premier cardiac surgeon, known internationally for his work.”

Avital is referring to Marc R. Katz, M.D., cardiac surgeon and director of the Bon Secours Heart & Vascular Institute. Katz, along with Stojadinovic and Avital made up the surgical team who cared for Peoples.

The complex surgery involved arresting the heart and a cardiopulmonary bypass. “This surgery was unique and rare because of the extent and complexity of the resections and the subsequent reconstruction of the vena cava and hepatic veins, plus the need for cardiopulmonary bypass.” said Marc R. Katz, M.D. Drs. Avital and Stojadinovic removed the tumors by removing the adrenal gland, right kidney, half of the liver and completely reconstructed the vena cava from the kidney to the right atrium, along with the hepatic veins.

“The tumor was situated in such an anatomic place and had grown to such an extent that it created an unusually complex surgical problem - one of the most involved surgeries I have been a part of,” said Stojadinovic. “I am not sure if anyone in Virginia has done a surgery like this. We had to reconstruct the vena cava vein, which is extremely rare. Placing this on a scale of complexity, this goes beyond even a heart or liver transplant.” The surgery was performed in the state-of-the-art Hybrid Operating Room at St. Mary’s Hospital. “We were grateful to have the technology of the Hybrid OR available to us,” said Avital. “It was the first time we assembled such a team – the varying disciplines as well as the extraordinary size of the team were all instrumental in a successful outcome for Kevon.”

Peoples is expected to do well, without further treatment for cancer. He will, however, continue on a regimen of medications to monitor his blood pressure and will need regular diagnostic check-ups as part of his recovery.

“We live to make people live longer; to make families happy,” Avital said. “That is what we love to do.”

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