Apollo Proton Cancer Centre successfully performed a Palliative Mastectomy for a patient with Metastatic Breast Cancer while the patient was singing. The Surgeon at Apollo Proton Cancer Centre said it was first time worldwide, a patient was awake & singing during breast cancer surgery, despite the extensive lung metastases, thus overcoming her anxiety.
Mrs. Seethalakshmi, a classical singer and teacher from Chennai was diagnosed with advanced breast cancer, walked into the Breast Oncology department at Apollo Proton Cancer Centre a few months ago. At that point of time, she was unable to speak a complete sentence, let alone sing, since the cancer had spread all over her body, and predominantly to her lungs. She improved so dramatically following few cycles of chemotherapy and targeted therapy, that she not only was able to get back to what she loved doing best, i.e. sing, but even resumed online classes for her students. While the multidisciplinary team arrived at the consensus of a palliative mastectomy for an ulcerated breast tumour; her treating surgeon and anaesthetist were faced with another challenge. The lung metastasis had caused extensive lung tissue damage, pneumothorax (air locking outside the lung), and fluid collection in both lung bases, rendering her unfit for general anaesthesia, not to forget the patient’s anxiety at undergoing a surgery.
Performing the surgical procedure under general anaesthesia for Mrs. Seethalakshmi was fraught with immense risk, and may have necessitated ventilator and ICU care for many days. In order to avoid such complications, Dr. Manjula Rao, Consultant Oncoplastic Breast Surgeon, and Dr. D. Indumathi, Consultant, Anaesthesiology decided to consider other alternatives. The patient was extensively counselled on three separate visits, by the doctors, regarding the various options available to her, and the pros and cons of each technique. Based on her output, Dr. Manjula Rao & Dr. Indumathi, decided to go ahead with performing the surgery under epidural anaesthesia, which involves delivery of the anaesthetic into a small catheter that is placed just inside the epidural space, which lies outside the spinal cord. At her request, they also decided to give her mild sedation during surgery to mitigate her anxiety.
On the day of surgery, when Mrs. Seethalakshmi was received in the recovery area of the operation theatre, she was anxious, as expected; despite being completely informed of the procedure, and multiple sessions of counselling. Her doctors played music to calm her nerves. The epidural catheter was introduced when she was well relaxed, and wheeled into the theatre, with soothing music playing in the background, all the while. As the saying goes, “where words fail, music speaks…” She was mildly sedated as per her request when Dr. Manjula Rao started operating, which was gradually weaned off and she was gently awakened, while surgery was halfway. Then, she proceeded to chat with her surgeon and anaesthetist, and later quoted, “the atmosphere in the theatre was cheerful and happy”. When requested to sing a song, she obliged, much to the joy, admiration and marvel of the treating team of doctors. She was shifted to Recovery ward, on completion of surgery, fully awake, comfortable, with no complaints of pain whatsoever, and very amused by the fact that she actually sang during surgery! Within an hour’s time, she was shifted to her room, oral feeding was begun, and she even walked to the restroom by herself, in two hours’ time. She was observed overnight, and discharged the following day.
Dr. Manjula Rao, Consultant, Oncoplastic Breast Surgeon, Apollo Proton Cancer Centre, said, “I am extremely delighted with Mrs. Seethalakshmi’s recovery, and satisfied to see how elaborate counselling and keeping the patient well informed of her various options, and shared decision making, have helped her go through critical surgery with such ease. The developments in research, modern medicines and new surgical techniques have together contributed in improving cancer patient’s overall quality of life, even in advanced stages. It is crucial for men and women to be mindful of any new symptoms and to report to their doctors at the earliest. The most common symptom of breast cancer is a painless lump, and if treated before the cancer spreads to the lymph nodes, the chances of complete cure goes up to 99%!”
Dr. Indumathi, Consultant, Anaesthesiologist, Apollo Proton Cancer Centre, said, “The possibility of considering alternate modalities of anaesthetic techniques in a patient at high risk for conventional general anaesthesia is key. The high-point of this case was detailed preoperative counselling, and listening to the patient’s needs and concerns, to keep her comfortable throughout the procedure, in addition to a well performed epidural block”.
On the occasion, Mr Harish Trivedi, Chief Executive Officer Apollo Proton Cancer Centre said, “We at Apollo Proton Cancer Centre(APCC) have been very passionate about giving ‘Tender Loving Care’ to our patients. At APCC it is practiced like a science. It consists of a deck of best practices, a wide range of systems that have been perfected to ensure that every process at APCC is patient-centric. The mental & psychological impact of the disease is quite significant. It is a tough battle and we are glad that we could help Seethalakshmi in our best capacity.”
Sharing his happiness on the treatment received, Patient Mrs Seethalakshmi said, “I’m a classical singer and teacher by profession. I love Ilayaraja songs and when we were entering into the operation theatre, I was listening to the music that made me sing during the surgery. Dr Manjula Rao and the entire Apollo Proton Cancer Centre team gave me hope and it is because of their expertise, skill and faith that I’m alive today. I will always be grateful and thankful to them for giving me a new lease of life.”
All in all, it was a very special moment, and made for a memorable day for the patient, the treating team of doctors, and a proud event for the Apollo Proton Cancer Centre, as they upheld their beloved Chairman’s values of delivering personalised cancer care with commitment and passion, while adhering to global standards of healthcare.
