PIG Meeting: 13th May 2021
74yo male for THR with multiple comorbidites including metastatic melanoma
- Melanoma – metastatic
- Acromegaly – transphenoidal resection, low level biochemical persistence, no further tx planned
- Cardiac disease – due to acromegaly, HCM and mild PHTN
- OSA – improved post adenoma resection, daytime somnolence and apnoeas resolved.
- Obesity BMI 50
- DASI 4.6 METS, limited by hip pain/function and fatigue
- Previous difficult spinal (failed attempts), difficult BMV but grade I ETT.
- Cardiac disease
- TTE arranged, very reassuring with nil significant abnormalities.
- ECG consistent with changes due to HTN/BMI/acromegaly
- Reviewed at cardiology-anaesthetics meeting. Ok to proceed with nil further imaging/review
- Melanoma/life expectancy
- Oncologist says pt a candidate for last-line immunomodulatory melanoma tx but will commence this after THR.
- If tx successful, patient may have years to live, if not then possibly only months.
- Should surgery proceed?
- Severe hip dx, affecting QoL ++
- Life expectancy may be dramatically improved by new therapy.
- Nil specific medical contraindications to surgery.
- Nil imminently life-threatening conditions, so if this man presented with a hip fracture, surgery would proceed. Given the severe pain/disability at present, perhaps could consider in the same way, as “palliative surgery”.
- Patient has had a previous THR (other side) in 2017, so is understanding of the rehab requirements and time spent away from family.
- Group consensus was to proceed with surgery