Lilavati Hospital Performs Successful Dual Surgery on 64-Year-Old with Colon Cancer and Heart Blockages

Mumbai: A team at Lilavati Hospital and Research Centre, led by Dr. Deepak Chhabra, Senior Gastro Cancer Surgeon, and Dr. Pavan Kumar, Senior Cardiac Surgeon, successfully performed complex surgeries on a patient with both heart disease and colon cancer, saving his life.

Dr Deepak Chhabra, Senior Gastro Cancer Surgeon, Lilavati Hospital said, “When the patient came to the hospital, he complained of weakness and weight loss over the last 3 months. His Haemoglobin was only 5gm% which is extremely low. His ECG showed some ischemic changes and angiography revealed more than 80% blocks of his main coronary arteries. A detailed evaluation of his anemia revealed that he had a cancerous growth on the right side of his large intestine. Unfortunately, this patient was diagnosed with three blockages of heart and colon cancer. Heart disease is a lifestyle-related disease and there has been a growing incidence of colon cancer in our country. No single cause can be attributed to its development. Westernized diets, alcohol, smoking, and tobacco have been associated with increasing risks of cancers. The heart problem needed a bypass surgery whereas, the colon cancer required a major abdominal surgery.

A skilled team consisting of a cardiologist, cardiac surgeon, and GI cancer surgeon drafted the treatment plan. "The situation was challenging. The patient experienced slight bleeding from his cancer with each bowel movement, which went unnoticed and resulted in anaemia. This caused further strain on the heart. The dilemma was whether to prioritize heart surgery or cancer surgery. Performing the cancer surgery first could have caused a severe heart attack due to the stress factors involved in any surgery. However, if heart surgery was conducted first, the patient would need to be on blood thinners to prevent blockage in the new grafts, which could have raised the risk of excessive bleeding from the cancer of the intestines,” explained Dr Chhabra.

“Patient had a critical coronary artery blockage involving left main artery along with colon cancer. The patient was very frail under 50kgs body weight with poor nutritional status because of this cardiac status he was a very high-risk anesthesia case for colon cancer surgery. So this patient needed urgent coronary artery bypass surgery. We did this bypass surgery taking all precautions considering his frail body and poor Hemodynamic status. He underwent triple vessel coronary bypass surgery successfully and recovered fully. This is a unique example of safe heart surgery to prepare patients for successful colon cancer surgery within 3 weeks so that cancer doesn’t spread. There are not many such cases of patients going for heart and cancer surgery together due to fear of cancer spreading to other body organs during heart surgery.,” Said Dr Pavan Kumar, Senior Cardiac Surgeon, Lilavati Hospital.

20 days later, preparing the patient for the surgery was challenging as blood thinners needed to be stopped before surgery. The patient needs to be given a liquid to cleanse his intestines as there can be dehydration and strain on the heart. The fluid intake and output have to be carefully managed before and after surgery. Instead of the regular wards, the patient was admitted directly to the ICU for monitoring in preparation for his surgery. He was scheduled for laparoscopic surgery for colon cancer management on 7th July 2024.

“The next challenge was the laparoscopic surgery itself. An open surgery would have posed a risk to the patient. A pneumoperitoneum (the process of creating a space in the abdominal cavity by using carbon dioxide gas) was needed for laparoscopic surgery and is known to pressurize the weak heart. Also, it's important to discontinue the blood thinners, which raises further concerns for patients who have recently had heart surgery. However, with the excellent efforts of the anesthesia team in coordination with cardiologists Dr Prakash Sanzgiri and Dr Vidya Suratkal, the patient underwent successful laparoscopic colon surgery. Colectomy involves the removal of some portion of the large intestine and stitching it back. Nowadays specialised technique is used where intestinal staplers are used that can cut and join the intestines which helps in saving time and fastens the procedure which was an absolute need in a patient like this. This minimally invasive surgery involves smaller incisions, minimal blood loss, shorter hospital stays, less pain, lower risk of infections, and quick recovery. This patient has recovered well now.”

The patient is thankful to the entire team of Lilavati doctors, especially Dr Deepak Chhabra. He said “ It was written for me and I had to face it. I was scared but the confidence and compassion of Dr Chhabra and his entire team has helped me navigate the rough waters I was in,” Said patient Mr Raman Dhingra (name changed).*

“Our hospital takes pride in having such expertise, equipment, and the necessary backup to deal with such challenging cases,” concluded Dr Niraj Uttamani, Chief Operating Officer at Lilavati Hospital & Research Centre, Bandra.