A Rare Cancer Surgery Performed by Doctors at Max Vaishali to Treat Tumor in Pancreatic Body
in Max Institute
Aug 22 , 2022
A 54-years-old female school teacher started experiencing some upper abdominal discomfort and feeling of fullness which did not improve with antacids. These symptoms persisted for a while, and she noticed weight loss too. She was diagnosed with a large tumor in the pancreatic body on evaluation. It extended to affect the celiac trunk (the artery that supplies blood to the entire upper gastrointestinal tract), its branch and the common hepatic artery (supplying blood to the liver). It also affected the adjacent adrenal gland, a 2 cm segment of the portal vein (the vein which drains blood from the entire intestine to the liver) and reached quite close to the superior mesenteric artery (the artery that supplies blood to the entire small bowel).
The patient visited Max Super Speciality Hospital, Vaishali, for treatment of her condition. The case was re-evaluated, and after a detailed discussion, she was planned for downstaging with Chemotherapy before surgery, followed by reassessment for surgery. She responded well to the Chemotherapy, with which the tumour shrunk slightly. On evaluation by the Gastrointestinal and Hepatopancreatobiliary Surgical Oncology team, led by Dr Vivek Mangla, it was decided that the tumour could be taken out by a very rarely performed surgical procedure known as Appleby’s Procedure along with the removal of a segment of portal vein involved by the tumour and left adrenal gland. The extensive procedure entailed the removal of a part of the pancreas, the spleen, and the involved arteries, carefully preserving a branch supplying blood to the duodenum and pancreatic head. The blood supply of the liver is ensured by the naturally occurring collateral circulation from the area of the pancreatic head. 
The procedure itself is quite challenging, and to add to the complexity, the case needed a segment of the portal vein to be removed with the tumour and the blood flow to be restored by joining the two ends of the veins together. Though challenging, this procedure was the patient’s only chance at having the tumour removed. The tumour was completely removed successfully in a surgery lasting around seven hours performed by a team of doctors including Surgeons, Anesthesiologists and Radiologists led by Dr Vivek Mangla.
It was a significant surgery, and its safety was ensured by carefully preserving the blood supply to the liver and confirming it on an intra-operative ultrasound Doppler test. The patient was discharged from the hospital about nine days after surgery and is recuperating at home.
Dr Vivek added that even though GI and HPB Surgical Oncology unit at Max Hospital, Vaishali performs about 500 surgeries a year, and about 30-40 for pancreatic diseases, this was a first for them. He further added that very few centres in North India had done this surgery.
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