CHANG GUNG MEMORIAL HOSPITAL
23rd June 2015
Salivary gland may also have a tumor? Da Vinci Made a Young Indonesian Man Smile Again
"It's so dark and windy; why hasn’t my brother come back from fishing?" Marco was a young man in his twenties from Indonesia. When young people of the same age were excitedly discussing where to hang out after class, he was pulling his fishing net with all his strength to support his family. He had even planned to go to Japan to catch bigger fish and make more money. However, an unfortunate thing happened - his physical examination report for applying to work in Japan showed abnormal data. Then, in January of 2015, a local physician diagnosed him with laryngeal carcinoma.
"Most of the money he made every month was sent to our home, and he only kept living expense equal to NTD 1,000 for himself. He didn't participate in any fun activities. He was very good and filial. So, when I heard from my dad that he was diagnosed with laryngeal carcinoma and would either die or become mute if he underwent surgical treatment, I was so sad and didn't want to give up. That's why I brought him to the Linkou Branch of Chang Gung Memorial Hospital in Taiwan. I believed that Taiwan had the medical capability to save him." Marco’s elder cousin continued his statement in a choked voice: "When Marco walked out of the office of that Malaysian doctor, he saw mute people all around him, which seemed to signify his own future. He was so terrified that he ran from the hospital and didn't return home for three days."
When we saw Marco for the first time, his diagnosis had already been confirmed for two months, and the local diagnosis in Malaysia had taken away all his optimism and liveliness, so he just drooped his head and sat next to his cousin, silently. Fang Duan-Ren, who was the Director of the E.N.T. Department at the Linkou Branch of Chang Gung Memorial Hospital was responsible for treating the patient. As a specialist of hypopharyngeal cancer surgery, he has conducted more than 1,000 laryngeal surgeries. Specialist Fang arranged an endoscopic biopsy of the patient’s pharynx and a CT scan for a thorough examination and evaluation regarding the position and size of the tumor. This is how he discovered that Marco suffered from a salivary gland tumor, not laryngeal carcinoma, and the result of the biopsy indicated that the tumor was benign. However, the tumor had increased from the size of a peanut to 5 cm in just two to three months. The rapid speed of growth meant that we could not relax our vigilance since a benign tumor may still have been mixed with a low-malignant tumor, which could be confirmed through biopsy after the surgical excision. However, Marco certainly would not become mute after the surgery, and his wound would recover by 70-80% in just one month after the surgery. Considering the nature of the tumor and postoperative care, Specialist Fang reached a consensus with Marco's family to replace the conventional endoscope with the Da Vinci Robotic System to perform the surgery.
Specialist Fang used the Da Vinci Robotic Arm to carefully excise the tumor transorally without injuring the adjacent tonsil. Just two days after the surgery, Marco could take a little food without relying on a nasogastric tube, and he did not present any complications, such as swallowing difficulty, susceptibility to choking during eating, food entering the nose, etc. Furthermore, he was able be discharged on postoperative day 4 with quite good recovery. Such success occurred because the Da Vinci Robotic System had facilitated a successful surgery and the patient was young with a good prognosis. When we visited Marco in his ward, he gave us a sunny smile. This was the first time that we had seen him smile so happily. We joked with him: "It turns out that your teeth are so white!" Marco's cousin said this was the originally optimistic Marco!
Marco hadn't held any hope for his future, but now, unexpectedly, he could finally say "thank you" to his physician in person. It is indescribable how excited he was! After learning that the postoperative biopsy indicated that the tumor was a benign pleomorphic adenoma, Marco couldn't wait to return home to see his family. The same disease would have been treated differently with different outcomes under different medical environments. Marco's cousin appreciates that Chang Gung Memorial Hospital started a beautiful new chapter of life for Marco and will recommend more local patients to the hospital after returning to his home country in order to prevent further avoidable tragedies.