Rare high risk breast cancer surgery done on patient with severe pulmonary hypertension

CHENNAI, June 30: In a remarkable demonstration of multidisciplinary coordination and advanced surgical planning, a high-risk breast cancer surgery was successfully performed at Apollo Proton Cancer Centre (APCC) here on a young woman with severe pulmonary arterial hypertension, a condition that significantly increases the risk of anaesthesia and surgery.

Severe pulmonary hypertension remains one of the most formidable risk factors in perioperative medicine, often deterring elective surgery due to the potential for cardiovascular collapse under anaesthesia, a hospital release said.

The patient, who was a known case of Systemic Lupus Erythematosus, had previously begun chemotherapy elsewhere but experienced a life-threatening collapse following her first cycle of treatment.

Upon referral to APCC, she was found to have pulmonary arterial pressures approaching 140 mmHg (normal value: less than 20 mmHg), placing her at extreme perioperative risk. Additionally, her platelet counts continued to decline even 1.5 months after completion of chemotherapy, further complicating her cancer treatment pathway and placing her at significant risk of becoming unfit for curative surgery.

However, the multidisciplinary team led by Breast Surgical Oncologist Dr. Manjula Rao and her team remained committed to pursuing

a curative treatment strategy, recognizing that the patient was under 40 years of age and had early-stage, potentially curable breast cancer.

The surgical team assembled a multidisciplinary team comprising specialists in anaesthesia, rheumatology, hematology, and cardiology, who worked collaboratively to stabilize her pulmonary pressures, improve her blood counts, and optimize her overall medical condition.

Through meticulous monitoring and coordinated medical management, the team was able to safely perform the breast cancer surgery, thereby enabling treatment with curative intent and significantly improving her prognosis.

Given the high anaesthetic risk associated with general anaesthesia in patients with severe pulmonary hypertension, the surgical team devised a carefully structured plan. The procedure was conducted under a high thoracic epidural block without sedation or muscle relaxants, allowing the surgery to be completed safely while minimising cardiopulmonary strain.

Stating that despite the significant challenges, the surgery was completed successfully within a carefully optimised time frame, Dr.Manjula Rao said the patient recovered well and was discharged home within 24 hours, fully mobile and stable. Today, nearly six months after completion of treatment, the patient remains disease-free, is enjoying a good quality of life, and has returned to her family and daily activities.

(UNI)