New Delhi, Delhi, India
- The outcome demonstrates the effectiveness of interdisciplinary collaboration at Max Healthcare
Doctors at BLK-Max Super Speciality Hospital successfully treated and gave a new lease of life to 67-year-old woman suffering from kidney cancer and blockages in major arteries in heart through two major surgeries within 2 days.
Led by a team of medical experts, including Dr. Surender Kumar Dabas, Vice Chairman, Oncology, Dr. Ramji Mehrotra, Chief, Cardiothoracic & Vascular Surgery and Dr. Vikas Thakran, Senior Consultant & Unit Head – Interventional Cardiology at BLK-Max Super Speciality Hospital, multi-disciplinary surgeries were performed, resulting in an optimal clinical outcome that defied all odds.
The patient was suffering from kidney cancer. She came to BLK-Max Hospital for the treatment. During evaluation, it was found that patient had class III angina, hypertension, and type 2 diabetes mellitus. Her coronary angiography showed significant triple vessel disease needing prior treatment to mitigate the increased risk of major cardiac events during cancer surgery.
The medical team collaboratively discussed and devised a comprehensive treatment plan to ensure the best outcome for the patient. The challenge was that the patient required complete revascularisation with four stents, necessitating dual antiplatelet therapy (giving blood thinners to prevent blood clots that can cause a heart attack or stroke). Delaying the nephrectomy surgery risked kidney cancer progression while performing it with single antiplatelet therapy was suboptimal.
The surgical plan involved coronary artery bypass surgery using bilateral mammary artery grafts and a robotic right radical nephrectomy the next day. Performing nephrectomy (Nephrectomy is the surgical removal of all or part of a kidney. It is usually done to prevent cancer spread) on a patient who had undergone major coronary bypass surgery posed significant challenges due to the risk of intra-operative bleeding.
Dr. Surender Kumar Dabas, Vice Chairman, Oncology, BLK-Max Super Speciality Hospital, “The utilisation of robotic surgery proved advantageous, allowing for a minimally invasive approach and precise vascular control. This approach reduced bleeding, magnified 3D visualization, and adherence to oncological principles. The safe robotic procedure enabled the early initiation of anticoagulants, crucial for post-coronary bypass care, leading to a rapid recovery and early ambulation. The patient’s progress was remarkable, and she was discharged on the 6th post-operative day.”
Dr. Ramji Mehrotra, Chief, Cardiothoracic & Vascular Surgery, BLK-Max Super Speciality Hospital said, “Embracing a comprehensive and collaborative approach our surgical strategy encompassed the utilisation of bilateral mammary artery grafts for coronary artery bypass surgery. By meticulously considering the challenges at hand, we aimed to optimise patient care through the exploration of safe myocardial revascularization with total arterial bypass, thereby striving for superior long-term outcomes. The arterial grafts have more chances of remaining patent even without blood thinners.”
Dr. Vikas Thakran, Senior Consultant & Unit Head, Interventional Cardiology, BLK-Max Super Speciality Hospital, highlighted the significance of the multidisciplinary approach, stating, “Non-cardiac surgery after myocardial revascularisation is a challenging scenario, often requiring a delay of several months. However, in this case, where delaying the oncological surgery was not an option, we employed a multi-disciplinary approach to address the underlying coronary artery disease simultaneously.”
This successful outcome exemplifies the power of a coordinated multidisciplinary approach, where experts from different medical specialties collaborate to mitigate risks and deliver optimal patient care.