Ground-breaking operation gives Dean a lifeline

A 36 year old man suffering from a rare form of cancer has been given a new lease of life thanks to a ground-breaking operation carried out at the Norfolk and Norwich University Hospital.

Dean Lawson developed a lump above his collar bone but thought nothing of it until scans revealed a tumour the size of an apple. He was at first thought to be suffering from lung cancer and given just one year to live.

Further biopsies showed he had a Ewing’s sarcoma of the first rib (a C-shaped bone that sits behind the collarbone), a condition which his surgeon, Mr Wyn Parry, believes is almost certainly unique in that location.

“Ewing’s sarcoma most commonly occurs in the bones of the leg, arm or pelvis. Disease in a rib is less common and I have never seen it in the first rib in my 20 years of experience as a chest surgeon,” said Mr Parry. “It is difficult from a surgeon’s point of view because access to remove a tumour in this rib is highly complex and carries significant risks to the patient.”

After a course of radiotherapy, Dean’s surgery involved making incisions into the neck and chest, splitting part of the breast bone and then peeling back the collarbone and muscles (the Grunenwald approach) to eventually remove the first rib and tumour completely, together with part of the top of the right lung.

“I’d encountered the Grunenwald approach in a medical journal but never seen it carried out or performed it myself,” said Mr Parry. “The anatomy around the first rib is extremely complex so I enlisted the help of Dr David Heylings, a senior lecturer in anatomy at the UEA, who allowed me to practise the procedure thoroughly on a cadaver in the medical school before tackling Dean’s operation.

“Removing the first rib is particularly challenging because the nerves to the entire arm, forearm and hand pass across the rib, in addition to major blood vessels to and from the arm. Damage to any of these structures could have resulted in major complications for Dean. In fact, he made a spectacular recovery and was chomping at the bit to go home after a couple of days.”

Dean, originally from Middlesborough but now living in Lowestoft, is undergoing chemotherapy and the outlook is good, although he will require prolonged follow up and review.

“I was living under a death sentence but the operation gave me a lifeline,” said Dean. “I’m so grateful to Mr Parry and also to my friends, Shaun Underdown and Gemma Searby, who have taken me under their wing and given me so much support over the last 14 months.

“Shaun the fiance of Gemma Searby who runs The Mariner’s Rest in Lowestoft, where I spend many hours helping out and socialising with customers, and we first met when he overheard me talking to my dad about my illness in the bar. He offered to take me to a football match and since then he has given me a home and a job and we have travelled to lots of European games together. He’s helped me to pack 10 years of living into a single year.”