Tuesday 17 February 2015

PM Lee Hsien Loong's operation a success, expected to recover fully

Many wish him speedy recovery after removal of cancerous prostate gland
By Rachel Au-Yong and Nur Asyiqin Mohamad Salleh, The Straits Times, 17 Feb 2015

PRIME Minister Lee Hsien Loong's surgery to remove his cancerous prostate gland was successful and he is now recovering in hospital, said his doctor.

"The surgery went very smoothly and he is expected to recover fully," Singapore General Hospital's lead urologist Christopher Cheng said in a statement issued by the Prime Minister's Office yesterday.

Professor Cheng, who operated on the Prime Minister earlier yesterday, confirmed that there is no relationship between Mr Lee's prostate cancer, which was diagnosed last month, and his previous bout of lymphoma in 1992. The latter is in remission.

The statement also said Mr Lee "is grateful for the good wishes from all".

On Sunday, the eve of his operation, he received at least 12,000 messages on his Facebook page wishing him well, following the announcement of his cancer.

Yesterday, there were more, as fellow politicians and members of the public cheered his successful surgery and wished him a speedy recovery.

Facebook user Vallen Yak said he saw Mr Lee being wheeled down an SGH corridor yesterday morning.

"Given his position, there will be no quibble even if they closed the corridor down just to wheel him on his hospital bed. Yet, he chose to allow normal operations to go on...

"Thank you for being a leader by example," he wrote.

Communications and Information Minister Yaacob Ibrahim told reporters at a community event that the Cabinet was surprised to learn of Mr Lee's cancer diagnosis.

"We pray for a speedy recovery for PM so that he can recover as quickly as possible, and come back and resume his normal duties," he said.

National Development Minister Khaw Boon Wan said: "PM should now focus on the recovery. We will continue to pray for his full recovery."

Mr Lee underwent robot- assisted keyhole surgery to remove his prostate, a walnut- sized gland in the male reproductive system located below the bladder.

The main function of the gland is to secrete prostate fluid, a component of semen.

Mr Lee is on a week's medical leave, during which Deputy Prime Minister Teo Chee Hean will stand in for him.

The Singapore stock market was slightly behind regional markets in the morning and one possible reason could be a knee-jerk reaction to the Prime Minister's announcement of his diagnosis on Sunday, said remisier Alvin Yong.

But sentiment picked up in the afternoon after news of Mr Lee's successful surgery, he added.

The Straits Times Index rose 0.94 points, or 0.03 per cent, to 3,427.16.

PM Lee Hsien Loong discharged from hospital, two days after surgery
The Straits Times, 18 Feb 2015

Prime Minister Lee Hsien Loong has been discharged from hospital, two days after a surgery to remove his prostate gland.

Professor Christopher Cheng, Mr Lee’s surgeon, said: “PM’s pathology report is good. The disease was small but potentially significant. We are very glad we were able to detect and remove it in time. PM should make a full recovery," the Prime Minister's Office (PMO) said in a statement on Wednesday.

In a Facebook post on Wednesday morning, Mr Lee said he had just met his doctors and that he was going home. "Home for Chinese New Year!" he added in Chinese.

Mr Lee had a video chat with ministers attending a Cabinet meeting on Tuesday morning, with several of them posting "Get well soon" messages on their own Facebook pages. 

President Tony Tan Keng Yam and his wife also visited Mr Lee in the hospital later that day. Dr Tan had shared that he was "good spirits and looking forward to being discharged".

One week off for PM - short, but enough
He should be well enough for work in a week: Docs
By Rachel Au-Yong, The Straits Times, 17 Feb 2015

WHILE his medical leave is considered relatively short to recover from surgery, doctors said Prime Minister Lee Hsien Loong should be well enough to return to work after a week of rest.

Mr Lee was given seven days of medical leave after he had robot- assisted keyhole surgery yesterday to remove his cancerous prostate gland.

Defence Minister Ng Eng Hen, a former cancer surgeon, said on Facebook that he used to give patients four to six weeks of medical leave to recuperate.

"I would tell them that, it may be keyhole on the outside, but full surgery has been done inside. Even after minimally invasive surgery, the body needs time to heal, (and) regain its energy and usual rhythm," he wrote.

Expressing hope that Mr Lee takes enough time to recover, Dr Ng said he is glad the surgery went well.

Robot-assisted keyhole surgery is a technique in which operations are performed through small incisions in the body, with the use of a robotic system (see graphic). Compared with open surgery, recovery is twice as quick.

Even so, urologists interviewed said that, like Dr Ng, they usually give patients four to six weeks of medical leave.

"Keyhole surgery operations are still major and complex," said Singapore Urological Association president Tan Yeh Hong.

After the prostate gland is removed, the bladder must be reconnected to the urethra. Thus, complications such as infection, the risk of bleeding and incontinence could arise, he added.

The possibility of such complications is why Dr Michael Wong, consultant urologist at Mount Elizabeth Medical Centre, typically wards his patients for two weeks.

"We want to watch them like a hawk, because most of the complications happen in that timeframe," he said.

After that, patients should avoid strenuous activities "like golf or running a marathon" for another two to four weeks, depending on their age and pre- existing conditions, he added.

Emeritus Senior Minister Goh Chok Tong, who had prostate cancer surgery last November, offered this advice on Facebook: "Over the next few weeks, he must be careful not to inadvertently tear the surgical stitches, especially the internal wounds."

It was the reason he discouraged people from visiting when he was recuperating, "so as to rest as and when I wanted", wrote Mr Goh, who returned to work after a week, like Mr Lee is expected to.

Urologists said patients can sit up and walk immediately after surgery, but must take care not to strain themselves.

Said Dr Tan: "PM is quite a busy person. I'm sure he will want to be there for the Budget. Most people have no problem returning to office work after a week, if they must."

Mr Lee's operation was done by Singapore General Hospital's lead urologist Christopher Cheng, a pioneer in using robots in surgery. Dr Wong said of Professor Cheng: "The PM is in good hands."

Robotic surgery the gold standard
By Ng Wan Qing, The Straits Times, 17 Feb 2015

ROBOTIC surgery is now the gold standard for prostate cancer treatment, as it provides the lowest risk of bleeding and the best outcomes.

It allows the surgeon to operate in any area deep within the body, where traditional open surgery and even keyhole surgery would pose challenges, said Dr Chin Chong Min, senior consultant urologist at Mount Elizabeth Novena Hospital.

The robot is ideal in confined spaces and controls up to three robotic arms with small articulate instruments to reproduce the surgeon's wrist movements.

These instruments have seven degrees of motion compared with four degrees for conventional laparoscopic (keyhole) instruments. The surgeon is also aided by software to eliminate hand tremors and operates with magnified, three-dimensional vision.

Surgery takes two to four hours compared with six hours for conventional laparoscopic surgery.

Patients with a medical profile and treatment similar to Prime Minister Lee Hsien Loong's have a high survival rate. The Prime Minister's Office cited data on Sunday to show that only one in 100 such patients succumbed to the cancer within 15 years.

PM Lee to undergo surgery for prostate cancer today
DPM Teo to stand in as PM while he goes on medical leave for a week
By Fiona Chan Deputy Political Editor And Tham Yuen-c, The Straits Times, 16 Feb 2015

PRIME Minister Lee Hsien Loong has been diagnosed with prostate cancer and will undergo surgery today to remove his prostate gland.

He will be on medical leave for a week and is expected to make a full recovery, the Prime Minister's Office (PMO) said in a statement yesterday.

The diagnosis comes 22 years after Mr Lee conquered an unrelated bout of lymphoma, a type of cancer that affects the immune system.

Last month, Mr Lee underwent a magnetic resonance imaging (MRI) scan that showed suspicious lesions on his prostate, a walnut-sized gland that is part of the male reproductive system.

A biopsy then detected the presence of cancer cells in one out of 38 samples, the PMO said.

Mr Lee took his doctors' advice to have his prostate gland removed via a keyhole prostatectomy. The robot-assisted procedure will be performed by Singapore General Hospital's lead urologist Christopher Cheng, a pioneer in using robots in surgery.

Words of concern and encouragement poured in from political leaders, MPs and members of the public yesterday, wishing Mr Lee a speedy return to health.

President Tony Tan said in a Facebook post that doctors expect Mr Lee to make a full recovery after the operation, "as the condition was detected early".

Deputy Prime Minister and Home Affairs Minister Teo Chee Hean, who will be Acting Prime Minister during Mr Lee's medical leave, hoped that Mr Lee would "rest well and recover fully" before resuming his "hectic" schedule.

Despite his cancer diagnosis, Mr Lee has kept active.

He spent a week in Germany and Spain on a working visit this month, sat in on a lively Parliament debate last week and attended an event in his Teck Ghee ward on Saturday.

In an upbeat post on Facebook yesterday, Mr Lee thanked his well-wishers and said he was "all set" for his operation today. The photo that accompanied the post was of himself in a hospital bed after the biopsy last month.

While the news of Mr Lee's cancer came as a surprise, most analysts interviewed expected government affairs to proceed as usual.

Former Nominated MP Zulkifli Baharudin said: "The Prime Minister has always believed that Singapore cannot depend on one man, that's why he assigns key projects to different ministers.

"Should any key office-holder, not just in politics but also in statutory boards, have to step down, the system will not collapse. That is a key feature of our system."

Well-wishers urged Mr Lee to focus on getting better. "Your good health will be the best SG50 present for Singaporeans," said Ms Luisa Teng in a comment on Mr Lee's Facebook post.

Prostate cancer is the third-most-common cancer among Singaporean men and usually occurs in older men. Mr Lee turned 63 last Tuesday.

Treatments include radiation therapy, hormone therapy, surgery and chemotherapy.

In November, Emeritus Senior Minister Goh Chok Tong, 73, had successful surgery to treat prostate cancer. He returned to work a week later and has received a clean bill of health.

Patients with a similar medical profile and treatment as Mr Lee have a high chance of surviving the cancer, the PMO said. It cited data showing that only one in 100 such patients succumbed to the cancer within 15 years.

Mr Teo will take over Mr Lee's duties this week, including attending the annual River Hongbao carnival to celebrate Chinese New Year.

Mr Lee is expected to be back at work in time for the Budget next Monday.

Get-well wishes for PM posted online
By Fiona Chan, Deputy Political Editor, The Straits Times, 16 Feb 2015

THOUSANDS of Singaporeans flooded the Internet with good wishes for Prime Minister Lee Hsien Loong yesterday, after learning that he had been diagnosed with prostate cancer.

They joined Cabinet ministers, MPs as well as opposition politicians in hoping for a swift recovery for Mr Lee, who is due to undergo surgery today to remove his prostate gland.

Supportive comments came in via various social media channels, with some posted on Mr Lee's Facebook page. Many expressed concern about his gruelling work schedule and urged him to focus on his health.

They included Mr Robert Lim, who said: "Matters of state are important but, in times like these, Singaporeans hope you can rest well and recuperate well."

Others urged Mr Lee to take more time off in order to recover after his operation. He will be on a week's medical leave and is expected to return to work in time for the annual Budget speech on Feb 23.

"Mr Lee, you should take more rest. One week is not enough," said Ms Esther Mei, in a comment on his Facebook page.

Noting that Mr Lee probably scheduled his surgery to coincide with the long Chinese New Year weekend, she entreated him to "please take care of your health".

Opposition parties also chimed in with their good wishes.

Workers' Party chairman Sylvia Lim told The Straits Times that her party "hopes the operation goes well and wishes him a speedy recovery".

Similar sentiments were echoed by both Singapore Democratic Party secretary-general Chee Soon Juan and Reform Party leader Kenneth Jeyaretnam.

Ministers who took to social media to wish Mr Lee well included Environment and Water Resources Minister Vivian Balakrishnan, Manpower Minister Tan Chuan-Jin, Social and Family Development Minister Chan Chun Sing and Minister in the Prime Minister's Office Lim Swee Say.

Deputy Prime Minister Teo Chee Hean, who will stand in for Mr Lee while he is on medical leave, summed up everyone's thoughts in wishing Mr Lee "a smooth operation and speedy recovery".

The ruling People's Action Party (PAP), of which Mr Lee is secretary-general, yesterday asked well-wishers to tag their posts with #GetwellsoonPM.

"Despite knowing of his illness, PM Lee has kept up a punishing schedule locally and internationally, most recently in helping to cement relations with Germany and Spain," the PAP said on its Facebook page.

In response to the outpouring of goodwill, Mr Lee yesterday thanked well-wishers for sending him their "concern, good wishes and encouraging words".

"I have already received so many e-mails, SMSes and messages through friends and contacts wishing me well," he said on Facebook.

In a display of continued good humour, he also posted a picture of himself in a hospital bed, holding up one of his fingers with a small electronic medical device attached to it.

The device, a pulse oximeter, tracks oxygen in a patient's bloodstream.

The photo was taken by Mr Lee's wife Ho Ching after his biopsy last month, he said.

"Ho Ching helped me take this selfie of ET phoning home," Mr Lee quipped, referring to the famous line from the 1982 science- fiction film, E.T. The Extra-Terrestrial.

The movie is about an alien named E.T. who is stranded on Earth, and whose finger - said to have a healing touch - lights up.

Being prepared for the unexpected
Editorial, The Straits Times, 17 Feb 2015

THE surgery for prostate cancer undergone by Prime Minister Lee Hsien Loong evoked much concern for his well-being. Although the operation is said to have gone well and PM Lee is expected to recover fully from his treatment, the suddenness of it all is a sobering reminder of the vagaries of physical health and also of the need for a sound management of succession risks and contingency in government.

Leadership succession plans at all levels lay the foundation of a system that can secure the nation despite the vicissitudes of supervening events. In statecraft, the collective responsibility of the Cabinet has proven to be a useful convention in buttressing a team approach that strengthens overall management without attenuating the prime minister's central role. This has contributed to the "business as usual" disposition here in times of significant political change. Leadership succession since Independence has been orderly, to the extent that the 1990 leadership transition, when Mr Lee Kuan Yew stepped down, was then described by his successor, Mr Goh Chok Tong, as a "non-event".

However, unlike the past two changes at the top, it is less clear now who might step into PM Lee's shoes in due time - "someone who can withstand the test and be able to secure the support of the people, someone who will stand out from our team", even as issues are becoming more complex, as PM Lee had noted.

In a sense, PM Lee's latest brush with cancer, together with his age, sharpens the import of changes that might flow from the next election, as his successor is expected to take over the reins during the next term of government. This assumes, of course, even unforeseen political changes remain manageable, as Singaporeans have become accustomed to expect. But that might prove to be a fraught premise should the future throw up a particularly discomfiting intersection of events.

The sobering news of the PM's ailment might thus cause citizens here to ponder the fragility of the nation's success. Things going swimmingly one day can turn suddenly, as unexpected political, social or economic currents emerge. City-states arguably face greater existential risks, if the fate of Venice and Florence is anything to go by. A hub, indeed any centre of commerce, is prone to various challenges from near and far; while a disparate polity based on symbiotic relationships is subject to the internal forces that can either hold it together or rend it apart. Against this backdrop, it would be prudent for Singaporeans to stay focused on the critical challenges at hand, and united in addressing them.

Today marks my third year on Facebook and Twitter. I hope you have enjoyed my posts. I’ve certainly had fun doing them,...
Posted by Lee Hsien Loong on Sunday, April 19, 2015

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