Bengaluru (Karnataka) [India], February 7 (ANI/PRNewswire): Sohail Akhter (name changed), 50 years of age from Bangladesh was suffering from a rare and complex form of cancer where a large mass of tumour affected his chest bone (sternum) with first 8 ribs on both left and the right side being involved.

The tumour also impacted the pericardium-the outer layer of the heart and the lungs. He roamed from country to country, one cancer hospital to another only to be turned down because there was no possible solution to his problem. The case was complex because even if the cancer was removed through surgery, there was no feasible solution to fix the chest bone (sternum) and the ribs, which were essential for breathing normally. Without it, the patient would be dependent on mechanical ventilation permanently.

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When the patient approached Manipal Hospitals, the oncologist team of Dr Somashekhar S P, Dr Rohit Kumar C along with Dr Ashwin Rajagopal evaluated the patient and held a joint meeting with the plastic surgeons, Dr Ashok B C, Dr Srikanth V and Dr Anantheshwar to manage this challenging case, determined to save his life.

Patient History

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The patient had a history of swelling in front of the chest for 6 years with no complaints of breathlessness or palpitations. He was managed conservatively in Bangladesh 6 years back. When the swelling in the front chest returned, he came to India for further treatment.

Medical Examination and Diagnosis

His biopsy reports were suggestive of a malignant tumour.

An MRI of the chest showed a tumour mass measuring about 15x12.7 cm sitting on the lung and heart that had completely destructed the entire length of the middle portion of the sternum or the chest bone (sternum is the long flat bone present at the centre of the chest that connects the ribs to form the ribcage). The tumour was bulging into the retrosternal space (inside the ribcage) and indenting the heart. Anteriorly, the mass was bulging to the subcutaneous space (the deepest layer of the skin) and was displacing the muscles of the chest wall around it and laterally bulging in the muscle planes.

Management: Tumour resection and sternum reconstruction surgery

After taking informed consent and thorough preoperative evaluation, he underwent tumour removal surgery under general anaesthesia. The entire chest bone (sternum) and ribs were removed without much blood loss. After tumour resection, the entire sternum and all the ribs on either side were reconstructed with an advanced 3D printed custom-made titanium implant. The new implant was fixed with a new drilling technique and titanium wire. The implant was a replica of the original chest bone and ribs that were removed during the surgery. It was custom-made before the surgery with the help of CT scan images of the patient's sternum and ribcages and 3D printing technology.

Elaborating on this new technology, Dr Somashekhar SP, Chairman & HOD - Surgical Oncology, Manipal Comprehensive Cancer Center, Manipal Hospitals, Bangalore, said, "The entire chest bone (sternum) and the costosternal junction was printed with titanium powder and liquid titanium and a new titanium chest bone (sternum) was formed, custom-made for this patient according to his size, height, weight and the portion of the skeleton to be removed. Multiple meetings were held with the company technologists, engineers and Manipal onco surgery and plastic surgery team for the same. However, such implants are usually very heavy upto 5 kgs. In this case, this would be too heavy for the patient to carry such weight on the chest. To rectify the same, a modified honeycomb technology was used to make the chest bone (sternum) and sternum weighing

(The above story is verified and authored by ANI staff, ANI is South Asia's leading multimedia news agency with over 100 bureaus in India, South Asia and across the globe. ANI brings the latest news on Politics and Current Affairs in India & around the World, Sports, Health, Fitness, Entertainment, & News. The views appearing in the above post do not reflect the opinions of LatestLY)