Saved by a team of surgeons

Upstate surgeons removed a 16-pound tumor, along with adjacent organs and vessels, from AJ Pass’ abdomen. Pathologists found no cancer cells along the edges of the tissue, a desired outcome referred to as "negative margins."

Owego man undergoes complex cancer operation

BY AMBER SMITH

AJ Pass had faith in his surgeons. He also knew he could die.

They had been straight with him: A proportion of patients who would undergo a surgery like he needed would not survive the operation.

Also, the mass they would remove was probably cancerous.

The week before, Pass, 36, was running an information technology company from his home in the Tioga County village of Owego, alongside his wife, who did her job as a marketing coordinator from home, too. Now the couple faced a multitude of worrisome decisions.

They were sure about Pass’ doctors, though: Mashaal Dhir, MD, and Gennady Bratslavsky, MD.

Pass enjoys trail riding near his home in Owego, about 18 miles west of Binghamton. (photo by Robert Mescavage)

“I felt like they truly loved me and cared about me in such a short period of time. Dr. Dhir had a way about him that was so gentle and calm,” Pass says. “And when I look back on it, I’m so grateful that Dr. Bratslavsky did not scare me.”

Pass’ medical crisis began as a weird abdominal pain that would only bother him in the morning. It left him alone the rest of the day, but it was back the next morning. His wife, Michelle, made him seek care. He wondered whether it might be a hernia.

The nurse practitioner Pass saw at Lourdes Hospital in nearby Binghamton sent him for a medical imaging scan. The results showed that Pass had what appeared to be a softball-sized cyst in the vicinity of his liver.

He got an appointment the next morning to see Dhir, a surgical oncologist and chief of hepatobiliary and pancreatic surgery at Upstate. More tests helped determine it wasn’t a liver cyst. The mass, which originated in his adrenal gland, was adjacent to his heart and growing into the inferior cava, the largest vein in the body, which returns blood to the heart. At its widest point, the mass was 15 centimeters, or about 6 inches. Surgery, Dhir told him, was the most effective treatment for such a mass.

After he met with Dhir, Pass got a phone call from Bratslavsky, who leads Upstate’s department of urology.

He was out of town but had discussed Pass’ case with Dhir.

Because the mass was growing so quickly and getting so close to Pass’ heart, Bratslavsky explained that “this was one of those rare scenarios where I felt we needed to proceed with surgery as soon as possible.”

Pass says Bratslavsky quickly put him at ease. “He was so confident he was going to be able to go in and fix it.” Pass never felt sick. He says he felt great the morning in April 2019 when he walked into Upstate University Hospital in downtown Syracuse for the surgery, which would last 12 hours.

Bratslavsky and Dhir teamed up with thoracic surgeon Mark Crye, MD, and transplant surgeon Rauf Shahbazov, MD, PhD, who has expertise in liver surgery.

Transplant surgeon Rauf Shahbazov, MD, PhD

The tumor started in the adrenal gland at the top of Pass’ right kidney. The gland and the organ had to be removed, along with half of his liver, half of his diaphragm and his vena cava, the largest vein in the body. And they had to be removed simultaneously, rather than sequentially.

“We remove masses like this en bloc,” Bratslavsky explains. “Everything comes out together. We make all the necessary maneuvers to be able to remove this mass with adjacent organs and vessels as one.” This requires a coordinated team, and it helps ensure that no stray tumor cells are left behind.

In Pass’ case, he had what surgeons triumphantly call “negative margins.” Pathologists found no cancer cells at the edges of the tissue that was removed.

The tumor weighed about 16 pounds and had grown to within a centimeter — two-fifths of an inch — of Pass’ heart. Doctors originally feared it might be an aggressive type of adrenal cancer. The tumor turned out to be Ewing’s sarcoma, a rare and aggressive cancer that often occurs in and around the bones, in children. It’s almost unheard of to arise in the adrenal gland of an adult.

Because this type of tumor is so rare, “there is really no good knowledge about how rapidly they grow, no understanding of its natural history and very little information on diagnosis and treatment,” Bratslavsky says.

Pass’ operation was complicated when his blood pressure dropped and his heart slowed. It did not stop beating, but Bratslavsky had to use his hand to pump Pass’ heart adequately. He praised the rapid intervention of heart surgeon Aqeel Sandhu, MD, who placed the patient on a cardiac bypass machine after the direct heart massage.

“I’m here because Dr. Bratslavsky didn’t give up,” Pass says.

Thoracic surgeon Mark Crye, MD

His left kidney stopped functioning — something Bratslavsky says may happen during big surgeries.

The kidney eventually resumed functioning on its own.

Pass remembers receiving anesthesia at the beginning and feeling comfortable surrounded by darkness. At one point, Pass says, “it felt like I fell through the bed and was just going through outer space at a million miles an hour.

I felt the wind, and I felt cold. It felt like an eternity. A white light was coming up from behind my back, getting brighter and brighter.

“I eventually hit what felt like a net, and slowly I slowed down. What felt like hands, or a force, lifted me back up through space, and someone was telling me my time was not over,” he says of his experience.

Pass was in a coma for six days after the surgery. A team of urologists from Bratslavsky’s department helped manage his recovery. He was well enough to go home after 24 days. Across his torso is a scar that looks like a Mercedes logo.

One month to the day after Pass traveled to Upstate for surgery, he was back in Syracuse. This time he was at Hancock International Airport, where he boarded a flight to Charlotte, North Carolina. His sister was getting married, and he needed to be there. Bratslavsky — not wanting his patient to endure an 11- to 12-hour car ride each way — opened his own pocket and surprised Pass with airfare.

Because Ewing’s sarcoma is known to recur, Pass now undergoes scans of his body every three months as a precaution.

He credits positron emission tomography, or PET scan, with finding a papillary thyroid carcinoma. Dhir operated again, to remove Pass’ thyroid gland, in June of 2020.

Then in October 2020, another scan revealed a spot in his left lung. His Upstate team recommended he see a specialist, so Pass traveled to the Cleveland Clinic in Ohio. Part of his lung was removed, and pathologists confirmed that the nodule was comprised of Ewing’s sarcoma cells.

Pass returned to Central New York with what he describes as a “pretty good prognosis” and plans to undergo chemotherapy with medical oncologist Rahul Seth, MD. As he prepares himself for more treatment, Pass reflects on how grateful he is for his surgical team. “They saved my life.”

Among the Upstate physicians caring for Pass are Mashaal Dhir, MD, left, a surgical oncologist and chief of surgical oncology for hepatobiliary and pancreatic surgery, and Gennady Bratslavsky, MD, chair of urology.

This article appears in the summer 2021 issue of Cancer Care magazine.

Read it online at issuu.com.

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