H.H.H.'s Cystectomy

Shortly after he emerged from the operating room following six hours of surgery at Manhattan's Memorial Sloan-Kettering Cancer Center last week, Hubert Humphrey asked his wife, "Muriel, how are the polls corning out in Minnesota?" That joshing question by a Senator virtually assured of re-election told as much about his condition as his doctors' optimistic prognosis. Though a cancerous bladder had just been removed, the 65-year-old former Vice President had lost none of his spirit, loquaciousness and will to survive--physically or politically.

Probably 30,000 Americans will find out this year that they have cancer of the bladder, a disease that strikes three times as many men as women. But if it is caught early enough--as it apparently was in Humphrey's case--the odds of beating it are better than even. Convinced that he had removed the entire tumor, a walnut-size growth at the base of the bladder, Humphrey's surgeon, Dr. Willet F. Whitmore, said confidently, "As far as we're concerned, the Senator is cured."

Prompt Treatment. Humphrey's chances were vastly improved by the fact that his doctors had been on the lookout for cancer ever since they had found and removed several pinhead-size nonmalignant growths in his bladder in 1968. Five years later, they discovered some new, possibly cancerous tissue, which was promptly treated with the anticancer drug thiotepa and sessions of X-ray therapy that took five minutes a day for five weeks. ("The worst experience in my life," Humphrey recalls.) The therapy worked and the Senator was found cancer-free for three years, but a recent examination at the National Naval Medical Center in Bethesda for symptoms of a urinary-tract infection turned up a low-grade malignancy that the doctors decided clearly required surgery.

Advised by his physicians and encouraged by his friends, including Senator Edward Kennedy, who has been supporting an uphill fight to elect him Senate Democratic leader, Humphrey placed himself in the hands of Memorial's Whitmore. Leading the team of five doctors, Urologist Whitmore performed an extremely difficult operation that he had helped pioneer in the early 1950s with his old mentor, Dr. Victor Marshall of New York Hospital-Cornell Medical Center.

Known as a radical cystectomy, it involved removal not only of the bladder (the body's reservoir for urine) but of other parts associated with the urinary tract as well: the prostate gland, the lymph nodes--which are being further examined to see if the cancer has spread to them--and fatty tissue around the bladder, and part of the urethra (the tube leading from the bladder through the penis). Such extensive surgery, Whitmore later explained, is routine in radical cystectomies (which his team performs at a rate of 80 to 100 a year), and does not mean that there is any malignancy beyond the bladder.

New Plumbing. To make up for the loss of the bladder, Whitmore had to install extensive new "plumbing." Taking the dangling ends of the ureters--the two tubes that normally carry the urine from the kidneys to the bladder--he connected them to a piece of "piping" or conduit made by snipping out a small piece of bowel. While preparing the conduit, Whitmore and his colleagues had to work with exceptional care, keeping intact the blood vessels feeding that excised section of small intestine. He then led the conduit to a small opening in Humphrey's skin that the surgical team had created just to the right of the navel. There, an external, flat plastic bag was attached (with glue), thus providing a urine reservoir that can be emptied at will.

If Humphrey's recovery proceeds as expected--two to three weeks in the hospital (at $350 a day, largely covered by his federal medical insurance), a month or more of convalescence--he should be able to resume his political career. Except for the pouch, the navel-to-pubis scar and the virtually inevitable impotence that results from such surgery, Humphrey will have few reminders of his ordeal on the operating table. He will be able to eat whatever he wants, work vigorously and even engage in such noncontact sports as golf or tennis.

Still, he and his doctors will have to remain vigilant. As added insurance against any recurrence of cancer, the Memorial team may offer him an experimental postoperative regimen of two new anticancer drugs, cis platinum and cytoxan. The objective: to kill any small clusters of cancerous cells that may have eluded the surgeon's scalpel.

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