Whipple’s procedure after Neo-adjuvant Chemo-radiotherapy: New hope for locally advanced, inoperable Pancreatic Cancers/Tumours

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Whipple’s procedure after Neo-adjuvant Chemo-radiotherapy: New hope for locally advanced, inoperable Pancreatic Cancers/Tumours
  • Surgical Gastroenterology team at Max Hospital performed successful Whipple’s Procedure after down staging (through chemo-radiotherapy) advanced pancreatic head cancer that had involved neighbouring major blood vessels.
  • At most other less well-endowed centres such cancers are deemed unrespectable and patients often undergo ‘bypass surgery’ or endoscopic stenting with no chance of cure .
  • Max hospital, Saket is one of the few centres in India that has all resources for successful combined modality treatment of such advanced pancreatic cancers.
  • This combined modality treatment offers new hope of extended survival or even cure to patients with advanced pancreatic cancers .

Case Summary

  • A young lady, Mrs. Shaymaa Abed Saadoon underwent ‘bypass operation’  in her home country for advanced pancreatic head cancer
  • Following down staging of the tumour by chemo-radiotherapy, she underwent a successful Whipple’s Procedure at Max Hospital whereby the tumour was completely removed (R0 resection)
  • There were no postoperative complications and she was discharged from hospital 7 days after surgery.

Doctors at Max Hospital, Saket, New Delhi recently performed Whipple’s Procedure after successfully downstaging the locally advanced pancreatic head cancer which initially was unresectable because of the involvement of neighbouring major blood vessels by tumor.

Mrs. Shaymaa Abed Saadoon, 39, hailing from Baghdad, Iraq was diagnosed to have cancer head of pancreas. At Iraq she was planned for Whipple’s procedure, however at surgery, tumor was found to be involving adjacent major blood vessels (SMV). Hence the cancer could not be removed and double bypass operation was performed. Determined to fight her disease she came to Max Hospital in October 2018.

On further evaluation at Max hospital, CT angiography of the abdomen displayed a large tumor involving adjacent major blood vessel i.e. superior mesenteric vein (SMV) the main vessels that drains blood from small & large intestine.  Following the reports, she was advised to undertake neo-adjuvant chemotherapy followed by radiation therapy in order to shrink the size of the tumour. She returned to her hometown for this part of the treatment. Last month, Mrs Shaymaa revisited the Max hospital, Saket following completion of chemo-radiotherapy in Baghdad. Her re-evaluation was suggestive of marked decrease in the size of tumor so that the earlier involved SMV now appeared free of tumor.

The patient was subsequently advised Whipple’s Procedure. Whipple’s procedure is a surgical process of removing the head of the pancreas, the duodenum, the gallbladder and the part of bile duct. The remaining organs are reattached to enable the patient to digest food normally post-surgery. The complex surgery was performed on July 11th. The surgery was challenging in view of dense adhesions due to previous double bypass surgery and loss of tissue planes with major blood vessels (IVC, SMA  & SMV) due to radiotherapy; however no vascular resection was required. The postoperative period was uneventful and she was discharged on seventh postoperative day.

Mrs. Shaymaa has now gone back to her normal daily routine. Her family has been extremely supportive all through.

Speaking about the case, the team of Dr Dinesh Singhal, Senior Director & HOD and Dr Nitin Vashistha, Senior Consultant, Surgical Gastroenterology, Max Super Speciality Hospital, Saket says, “Whipple’s procedure is technically one of the most demanding abdominal operations. In this case, previous surgery and subsequent radiotherapy added substantially to the complexity and risks of the procedure. The final biopsy report suggesting that ‘all margins were free of tumor’ was particularly gratifying. This innovative treatment offers new hope for the patients with locally advanced pancreatic head cancers that were earlier deemed inoperable”Fresh from a recent visit to The Johns Hopkins Hospital, Baltimore for Robotic pancreatic surgerythey further added,“Even in the US, Whipple’s procedure in such a setting is limited to centres of excellence only but there the cost is prohibitive and unaffordable for most Indians. Max Hospital Saket and team SGE now join a select group of Indian hospitals that offers this combined modality treatment at affordable Indian costs.”

Neeraj Vats

Neeraj Vats

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