Times of India
11 January 2009
By Madhavi Rajadhyaksha
Mumbai, India.

Having every drop of blood sucked out of one’s body might sound like sci–fi. But that is what happened to Portugal resident and retired judge Antonio Soaias (77) who was rendered ‘Clinically dead’ for 30 minutes for a highly complex surgery at Bombay Hospital.

Soaias was holidaying in Goa but the trip was rudely cut short when he developed unbearable pain in his legs. His relatives took him to Manipal Hospital in Panjim where scans indicated cancer of the kidney. It was only when doctors opened him up for a surgery on December 23 that they found a tumour stretching from his right kidney and eating into 30 % of his heart instead.

Then he had no blood

• Retired Potugal judge Antonio Soaias, 77, was holidaying in Goa when he was diagnosed with kidney cancer
• During operation, Panjim doctors found he had a 17–cm tumour stretching from his right kidney into his heart
• He was rushed to Mumbai, where docs drained out his blood to render him ‘Clinically dead’ for 30 min to take out the tumour. Then his blood was slowly put back again into circulation Mumbai doctors remove tumour in a ‘Blood–less’ surgery

Mumbai: Portugal resident and retired judge Antonio Soaias (77) received a new lease of life on the first day of the new year, after he survived an eight–hourlong cutting edge surgery to remove a 17–cm–long tumour from his body. The tumour stretched from his right kidney and ate into 30 % of his heart.

“At first, we thought his kidney had been affected because of diabetes, but we didn’t know what to do when they told us about the tumour. We didn’t even tell Antonio,” recalls his wife Carolina. By a stroke of luck, the Goa doctor from a hospital where he was admitted, recalled a similar surgery done in the Bombay Hospital 15 years ago and suggested that the family head there.

The judge was flown to Mumbai and rushed to the Bombay Hospital, where the tumour was removed.

Calling his condition one of the “Rarest of rare” seen in medical literature, cardiothoracic and vascular surgeon Anand Somaya, who operated upon him, explained that in Soaias’ case, the cancer had spread from the right kidney, entered the inferior vena cava (the large vein that carries deoxygenated blood from the lower half of the body to the right atrium of the heart), travelled through the liver into the right atrium of the heart.

While tumours entering the inferior vena cava are seen, they enter the heart in 0.5 % of cases.

“When the tumour is inside the blood vessel, doctors need to take all the blood out, so that they can remove the tumour in a bloodless field. While we find tumours entering the inferior vena cava, they rarely enter the heart,” said Dr Somaya. This is unlike usual heart surgeries which use a heart–lung machine to keep the blood pumping and maintain the patient’s blood pressure. Soaias made for a challenging patient as he suffers from diabetes, and had a mild form of Parkinson’s.

Taken up for the surgery on January 1, Soaias was cooled from 37 degrees to a temperature of 17 degrees Celsius (by passing the blood through a heart–lung machine) and his blood was completely taken out. “At that point, he is ‘clinically dead’ – nothing works, neither the heart, lungs or brain. A person can survive like that (without oxygen) for 45 minutes, and his surgery took 30 minutes,” said Dr Somaya who performed the operation along with cancer surgeon J N Kulkarni and anaesthetist Pradnya Kulkarni. The procedure is medically called deep hypothermia with circulatory arrest.

The surgeons then skillfully removed the tumour in one piece, measuring it to 17 cm. Once done it took two hours to rewarm the blood back to 37.4 degrees Celsius and re–start Soaias’ circulation.

The operation cost them Rs 8 lakh, but the Soaias’ are relieved it’s all over. “I am eagerly waiting to get home and meet my grandchildren,” said Antonio from his ICU bed in Bombay Hospital, even as a relieved Carolina said this was one holiday to India they wouldn’t forget.

Independent doctors, however, said such cases aren’t unheard of. “I have seen around eight such cases which happen in cases of renal carcinoma,” said cardiothoracic surgeon and chief of Asian Heart Institute Ramakant Panda. He said circulatory arrest, in which patients are ‘Cooled’, are used in types of cardiac surgeries such as these and aneurysms.

“I would consider it a remarkable surgical achievement but I can’t vouch that it is a very rare case as such cases have been reported in Indian and international literature,” said senior cardiologist and surgeon G B Parulekar. “It is an expected condition, but I don’t recall a recent case in India,” he said.