This case takes place in New York and involves a patient who had been diagnosed with lymphatic cancer that had affected the lymph nodes around her stomach. After the patient received this diagnosis, she sought treatment at another hospital, where a surgical procedure was recommended to remove the affected tissue. The second hospital had written regulations that stated all diagnoses must be confirmed by in-house physicians before surgical treatments can be undertaken. Despite this written regulation, the treating surgeon decided to proceed with surgery on the patient without a confirmed diagnosis from one of his hospital’s own physicians. The surgeon performed a Whipple procedure in an attempt to remove the affected tissue. After the surgery was completed, it was discovered that the patient had a different form of cancer than the one detailed in the original diagnosis. The Plaintiff alleged that the surgery that was performed was inappropriate and unnecessary, and that the treating surgeon was negligent in failing to confirm the diagnosis before proceeding in accordance with hospital protocol. Nevertheless, the treating surgeon claimed that a Whipple procedure was the only valid treatment for both the original and revised diagnoses.
Question(s) For Expert Witness
- 1. Is the Whipple procedure the only means for treating this cancer? Please explain.
Expert Witness Response E-005040
A Whipple procedure is not considered standard of care for this particular type of cancer. It would be important to know how the initial diagnosis was made. If you have a cancerous growth localized in a lymph node of this region of the digestive tract, this is generally a sign of metastatic cancer. There are a large variety of cancers that may spread to the nodes of the region in question, include hepatocellular carcinoma, cholangiocarcinoma, pancreatic cancer, colon cancer, gastric cancer, and esophageal cancer. Therefore, prior to planning any surgery, it would be important to perform a number of tests – certainly a colonoscopy would be warranted, in addition to EGD and a CT scan of abdomen and pelvis. Depending on the results of those initial tests a PET/CT and an upper GI EUS may also be indicated. Finally, Immunoistochemistry studies could have also helped in identifying the primary tumor. No surgeon should perform a Whipple in a patient for a metastatic node in absence of an identified primary tumor. This particular variety of cancer has a very different histologic appearance from lymphoma, and the odds are very small that a pathologist would have interpreted a lymphoma as this. Nevertheless, Whipple is not an accepted treatment for lymphomas localized at this region of the GI tract.