Fortis doctors perform rare 'dual surgery' for tumours in breast, heart

Fortis doctors perform rare 'dual surgery' on a 55 years old female patient who was diagnosed with a malignant tumor in her breast and a benign tumor in her left atrium. The 55-year-old from Uttar Pradesh underwent back-to-back surgeries for both tumors in her breast and heart, doctors said on Thursday.

The patient was admitted to the hospital with cancer in her right breast. A CT scan of her chest revealed clear lungs, but a malignant mass in her breast and something in her heart (left atrium) which was asymptomatic, the hospital said in a statement.

"A team of doctors from Fortis Hospital, Vasant Kunj in south Delhi, consisting of oncologists, cardiologists, radiologists, anesthesiologists, and critical care specialists, conducted simultaneous open-heart surgery and segmental mastectomy under general anesthesia on the 55-year-old patient from Gorakhpur," it said.

This form of dual surgery is "rare and the first of its kind," the hospital claimed, saying the surgery was conducted recently.

The doctors said the cardiology team's tests suggested that the mass or lesion in the heart was an atrial myxoma, a benign cardiac tumor.

With the presentation of evidence of two separate tumors -- one in the breast and one in the heart -- treatment options were narrowed, they said.

The team assessed the situation as the malignant tumor in the breast needed to be treated urgently and treatment involved surgery, chemotherapy, targeted immunotherapy, radiation, and hormonal therapy.

The treating team consisted of Dr. Mandeep Malhotra, Dr. Tapan Ghose, and Dr. Sanjay Gupta.

Sanjay Gupta, Director, Cardiac Surgery and Cardio Thoracic Vascular Surgery at the hospital, said, "Another challenge under the circumstances was that immunotherapy and certain chemotherapeutic drugs, sometimes cause weakening of heart, therefore heart function should be at its optimum best to withstand the treatment".

Mandeep Malhotra, Head, Department of Head-Neck and Breast Oncoplasty at the hospital, said, "The histopathology of the patient proved that she was suffering from stage 3 breast cancer with atrial myxoma. Profiling showed that she was an ideal candidate for targeted therapy in the form of Trazatususmab, which often causes weakening of the heart."

"Had we operated the heart only, delaying the surgery for the breast, then this could have led to the progression of cancer impacting the patient's survival. Therefore, in order to ensure survival and proper treatment, the heart needed to be stable. Only then could the treatment for breast cancer be properly administered and completed.

"It was, therefore, decided in our medical board in consultation with the patient, that both the operations would be done together, and the patient would be placed under general anesthesia," he said.

She then underwent an open-heart surgery first, and after the chest was closed and the patient stabilized, the breast was operated on to remove cancer, the statement said.

She was kept in the ICU for 48 hours, following which she was shifted to the ward. Her post-operative period was smooth and she was discharged six days after the surgery.