TUCSON, Ariz. -- In a complex, 10-hour operation, surgeons at The University of Arizona Medical Center successfully removed a 47.5-pound tumor from a Tucson woman. Despite suffering cardiac arrest during the procedure, the team of surgeons, anesthesiologists and nurses brought Marcey DiCaro successfully through the surgery.
Three years prior to surgery, DiCaro noticed her belly getting bigger, but attributed it to weight gain. She was experiencing transient pain in her upper right quadrant, and eventually the pain remained constant.
DiCaro, who had no health insurance at the time of diagnosis, had a scan that revealed a large tumor in March 2012. With preexisting conditions, finding insurance was very difficult, but DiCaro eventually found a plan she thought would cover the procedure. Surgery was scheduled in 2013, but her operation was cancelled the night before because of more issues with her insurance coverage.
Finally, in 2014, DiCaro was able to acquire insurance coverage that would cover preexisting conditions through the Affordable Care Act. She underwent surgery April 17. By then, surgery had become more complicated with the growth of the tumor and the involvement of other organs.
The tumor, a massive liposarcoma, had invaded DiCaro’s inferior vena cava – the body’s largest vein, which carries blood from the body back to the heart – and her kidney, making the procedure especially high-risk.
Surgical reconstruction of the inferior vena cava is a formidable, delicate procedure that requires a highly skilled surgical team. However, if the tumor had not been removed, it would have invaded other organs and been fatal.
"Because the tumor had been pressing on the vena cava, it created a blood clot in the vein," said Tun Jie, MD, interim chief of the Division of Abdominal Transplant Surgery in the UA Department of Surgery. "The surgery was quite challenging. This was a situation that was not easy to tackle and not all surgeons would have gone forward with it."
Drs. Jie and his team, including general surgery chief resident Angela Echeverria, MD, decided the benefits of surgery far outweighed the risks. Said Dr. Echeverria, "We knew that without surgery, the tumor was going to become larger, worsening her condition."
"After we dissected the tumor off the inferior vena cava, it looked like Swiss cheese," Dr. Echeverria said about the surgery. "There were so many holes in it due to tumor invasion. We took that segment out and reconstructed a new inferior vena cava."
Dr. Echeverria said that one of DiCaro’s kidneys also was encased by the tumor and removed, along with her gall bladder.
Following a two-week hospital stay, DiCaro was back at home. "She has had the most impressive recovery of any patient I have had," Dr. Echeverria said.
This was not the largest tumor Dr. Jie has removed; he once removed a 60-pound tumor from a patient’s abdomen. However, large tumors like DiCaro’s are very unusual, he said.
"If the tumor had been let go, it would have killed me," DiCaro said. "I am grateful for insurance and I was immensely happy with my care. I felt great confidence in Dr. Jie’s abilities. The whole team approach was wonderful. I’m happy to be going on walks and getting back in the pool and getting out and enjoying life."
Said Dr. Echeverria, "She is doing absolutely great and she is the best patient you could ever ask for. She is a very sweet lady and I am glad we were able to help her."
Dr. Jie said the UA team made the surgery a success. "It’s all about team work and I’m glad to see she is doing so well."