Case report of a Modified Radical Mastectomy performed under Thoracic Epidural Anesthesia

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Case report of a Modified Radical Mastectomy
performed under Thoracic Epidural Anesthesia

• Dr Lukram Ajit Singh
• MBBS, DNB (Gen Surgery). Sr Registrar Oncosurgery
• Dr Gautam Mukhopadhyay
• Consultant Oncosurgeon HOD of Onco surgery
• Dr Abhijeet Banerjee
• Anesthetist

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Case history in brief

• Mrs. SB Ray a 70 years old lady and a resident of
  Barrack pore presented with a breast lump in her
  right breast on 11/08/10. The lump was there for
  2 months, gradually increasing in size.
• On clinical evaluation, there was a hard lump
  with irregular surface and borders measuring 4/4
  cm in size and occupying the upper outer quadrant
  of the right breast. The lump was not fixed to
  skin and surrounding tissues.
• No axillary nodes were palpable and no signs of
  distant metastasis was present.
• FNAC Duct carcinoma of right breast.

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Staging and Plan

• Stage Clinical staging T2 N0 M0
• Plan Modified Radical Mastectomy
• Co morbidities in the patient prevented us
  from going ahead with a routine MRM.
• On further work up for surgery patient was
  found to have a very poor pulmonary function test
  and was declared unfit for general anesthesia by
  the medical team (anesthetist, chest and general
  physicians) looking after her.

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Dilemma

• An operable case of breast cancer and the brave
  70yrs old lady ever willing to undergo any type
  of surgery to make her life cancer free and the
  poor lung compliance made us think out of the
  box.
• We planned to go ahead with the MRM under
  thoracic epidural anesthesia and try our best to
  treat this lady.

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Informed consent and surgery

• After discussion about the technique and nature
  of the procedure with the patient and her
  relatives, we went ahead with our planned MRM
  under thoracic epidural anesthesia on 14/08/2010.
• Patient underwent modified radical mastectomy
  with complete axillary clearance upto level III.
• The procedure was uneventful, surgery was
  satisfactory and the thoracic epidural anesthesia
  that we chose worked well !!

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Thoracic epidural anesthesia

• Is a safe way of anesthesia in patients unfit for
  GA.
• Our surgery is one of the rare recorded MRM s
  performed under thoracic epidural anesthesia.
• Patient was given her due treatment through this
  form of anesthesia.
• She had come back after the surgery for follow up
  and received her 1st cycle of chemotherapy.

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My first 2 weeks in the dept of Oncosurgery at
Ruby General Hospital

• This is my log book in 14 days(Sept1 to 14) and
  is still counting Total 21 cases
• Modified Radical Mastectomy- 5 cases
• Hemimandibulectomy-3 cases
• Oral Laser surgery- 4 cases
• Total Thyroidectomy- 2 cases
• Modified Radical Neck Dissections- 3 cases
• Abdomino perineal resections- 1 case
• Exploratory laparotomy and enterostomies-2
• Excision of soft tissue malignancy-1

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LEUCOPLAKIAORAL LASER EXCISION AND FULGURATION
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BREAST CANCER-MRM
10
DECOMPRESSION ENTEROSTOMY-PALLIATIVE SURGERY IN
INOPERABLE GI CANCER
11
HEMIMANDIBULECTOMY WAS DONE
12
THYROID CA TOTAL THYROIDECTOMY
13
APR FOR RECTAL CA
14

• Thank you.