Highly specialised, minimally invasive expertise guided by international collaboration

When all surgical options to remove cancerous nodes near a man’s trachea had been exhausted, he was determined to find another way. His deep dive into international research online led him to a team of pioneering interventional radiologists with the rare expertise to perform this highly sophisticated, minimally invasive treatment at Netcare University of Cape Town (UCT) Private Academic Hospital. 

“In 2012 I was diagnosed with papillary thyroid carcinoma, and first I had a partial thyroidectomy, then, after recurrence a few years later, a full thyroidectomy plus an oral radioactive iodine treatment. However, regular recurrences continued and in total I had nine surgeries on my neck over 12 years,” says Martin Horn, 62, of Somerset West. The very first of these surgeries severed a nerve to one of his vocal cords, forever changing the pitch of his voice. 

“Recent blood tests and ultrasound identified that there was still a small tumour growing close to my windpipe, but more surgery was not considered a good option for me. So, I started researching for myself what could be done,” he says. 

This led Mr Horn to learn about cryoablation, a less invasive option for treating small tumours deep within the body by freezing the tissue, which can be done without the need for open surgery. “I discovered a 2023 US research paper with 10 papillary thyroid cancer patients in a very similar situation to mine, where cryoablation showed a significant success rate. I showed this study to my own oncologist to ask if we could explore this for me.

“We didn’t know whether anyone in SA could perform this minimally invasive cryoablation so close to my trachea. I learned that cryoablation is gaining ground for treating certain breast cancers in Johannesburg, however the location of my tumour required a different set of sub-specialised expertise, and it was beginning to look as though travelling overseas for the procedure was my only option. It would, however, be considerably more expensive for me, as my medical scheme would likely not cover the costs,” Mr Horn says. 

His search led him to schedule an appointment with interventional radiologist Dr Gercois Human, who practises at Netcare UCT Private Academic Hospital. Dr Human undertook advanced international fellowship training in minimally invasive, image-guided therapies at McGill University in Montreal and in abdominal imaging at the University of Toronto in Canada.

Together with Dr Dale Creamer and the Cape Town Interventional Radiology team, Dr Human is one of only a handful of subspecialists in South Africa with the necessary expertise to perform the highly specialised procedure for Mr Horn at Netcare UCT Private Academic Hospital. Their rare interventional radiology expertise also enhances the options available for treating liver, gallbladder, and pancreatic conditions percutaneously and via the peripheral vascular system through the multidisciplinary Liver Centre SA. 

“The considerable build-up of scar tissue from previous surgeries meant that it would be extremely difficult for surgeons to distinguish a tumour of this size, and traditional surgery so close to the trachea comes with additional risks. Essentially, surgical options for this patient had been exhausted when he turned to us for assistance,” Dr Human says. 

Interventional radiologists use real-time, detailed imaging to perform intricate, highly targeted procedures from within the blood vessels. These less invasive procedures can, in appropriate instances, offer a crucial alternative to open surgery, significantly reducing the associated physical trauma while cutting recovery times from weeks to days in many cases. 

“Through interventional radiology, cryoablation freezes the tumour and a small margin of tissue around it to destroy the cancer. Overseas, this has been used to treat this type of cancer, but in South Africa, it was quite novel. Historically, interventional radiologists who trained internationally in procedures such as this did not return to practise in South Africa,” Dr Human says. 

Affiliated with the European Society of Interventional Radiology, he explains that the Cape Town Interventional Radiology team collaborates with multidisciplinary teams at Netcare UCT Private Academic and Netcare Greenacres hospitals, and maintains close ties with international experts in the field.

“Our Canadian mentors shared valuable insights before this procedure, and this ongoing collaboration ensures our patients benefit from years of collective experience,” Dr Human notes.

Mr Horn says he was conscious, although sedated for the procedure, and he drifted off to awaken back in the ward with only a small puncture in his neck. 

“This was worlds away from the experience of surgeries I have had before. I was able to return home the same day, and the next day I was back to my normal life. I’ll have regular check-ups with my oncologist to monitor my progress, but I want others who may be in a similar situation to mine to know that these options are now available in our country,” he says.

Dr Human points out that interventional radiology can be helpful for many conditions, but it should only be used when clinically appropriate and supported by evidence-based benefits. 

“We aim to strengthen the availability of world-class cancer treatment options and minimally invasive procedures locally. These skills are scarce in South Africa, and to address this, Dr Jateel Kassim has joined our team as the first interventional radiology fellow in South Africa,” he says. 

“Through developing these additional treatment options, our country is taking its place at the forefront of advanced medical practices,” Dr Human concludes. 

For more information, visit the Cape Town Interventional Radiology website www.CTIR.co.za.