Successful complex surgery for advanced-stage large Intestinal Tumour
in Max Super Speciality Hospital, Vaishali
Apr 18 , 2023
Pertaining to the fact that there has been a significant rise in Gastrointestinal tract cancers (GI Tract) and to increase awareness amongst the public about the recent advancements made in its treatment modalities, Max Super Speciality Hospital, Vaishali, organised a public awareness session. The session was orated by Dr. Vivek Mangla, Director, GI & HPB Surgical Oncology, who showcased a recently treated from Haldwani.
A 60-year-old patient was diagnosed with advanced colonic (large intestine) cancer with involvement of 1st and 2nd part of the duodenum (proximal-most part of the small intestine) in December 2021. He had been treated outside with chemotherapy, to which he responded partially, but then he stopped the treatment. Over time, his condition worsened with recurrent vomiting, poor oral intake and significant weight loss.
In July 2022, he visited Max Hospital, Vaishali, in a cachectic state, with a large mass involving the colon and duodenum (the proximal-most part of the small intestine) with both partial colonic and high-grade duodenal obstruction without any distant metastases and was oered palliative (non-curative) treatment outside. The case was reviewed by the GI Tumour Board at Max Hospital, Vaishali. He was planned for curative intent treatment with initial nutritional build-up with tube feeding. During the nutritional build-up, he was also given chemotherapy to halt disease progression. Reassessment showed a partial response to chemotherapy.
At this point, a major surgery lasting about 10 hours, entailing the removal of the organs involved by the tumour (pancreatic head, duodenum, gall bladder, bile duct, right side of colon, a part of stomach, a part of proximal and distal small intestine) technically called an En Bloc.
Whipple with radical (D3) right colectomy was done on 28th October 2022 at Max Hospital, Vaishali by a team led by Dr. Vivek Mangla. The patient had an uneventful recovery and was discharged a week later. The patient has recovered, is eating well, is regaining weight and has returned to Haldwani.
This case highlights that excellent outcomes can be achieved, even in patients with advanced colonic cancer, when managed by a dedicated team, willing to put a lot of extra eort into an individual patient. Firm resolve of the patients and their families and good treatment planning followed by a perfect execution by the treating team are needed when managing such complex patients and surgeries. Dr. Vivek added that less than 1000 such surgeries (combined Whipple's with Radical Colectomy) had been done worldwide, with very few having been done in India for colonic cancer.
He also added that they had done this procedure as part of an even more major surgery once earlier, too, 3 years ago, in a patient with a large retroperitoneal tumour, which needed the removal of additional organs. The case was also reported in the media, and the patient is now disease free and doing well. Such surgeries are being routinely performed by our team, whenever indicated, in patients with abdominal cancers, he added.
Gastrointestinal cancers impact the large intestine, GI tract and digestive system, including the oesophagus, stomach, small and large intestines, liver, gallbladder, pancreas, etc. Max Hospital, Vaishali, has a dedicated unit providing comprehensive cancer care for patients with these cancers. Amongst these cancers, colorectal cancer has the best outcomes with treatment stage-by-stage. Colorectal cancers originate from any part of the large intestine in the abdomen as ulcers or masses and can metastasise to the other parts, if not detected timely. Most patients with even widespread colorectal cancer live longer, productive lives with modern treatment, and some can even be cured.
A 60-year-old patient was diagnosed with advanced colonic (large intestine) cancer with involvement of 1st and 2nd part of the duodenum (proximal-most part of the small intestine) in December 2021. He had been treated outside with chemotherapy, to which he responded partially, but then he stopped the treatment. Over time, his condition worsened with recurrent vomiting, poor oral intake and significant weight loss.
In July 2022, he visited Max Hospital, Vaishali, in a cachectic state, with a large mass involving the colon and duodenum (the proximal-most part of the small intestine) with both partial colonic and high-grade duodenal obstruction without any distant metastases and was oered palliative (non-curative) treatment outside. The case was reviewed by the GI Tumour Board at Max Hospital, Vaishali. He was planned for curative intent treatment with initial nutritional build-up with tube feeding. During the nutritional build-up, he was also given chemotherapy to halt disease progression. Reassessment showed a partial response to chemotherapy.
At this point, a major surgery lasting about 10 hours, entailing the removal of the organs involved by the tumour (pancreatic head, duodenum, gall bladder, bile duct, right side of colon, a part of stomach, a part of proximal and distal small intestine) technically called an En Bloc.
Whipple with radical (D3) right colectomy was done on 28th October 2022 at Max Hospital, Vaishali by a team led by Dr. Vivek Mangla. The patient had an uneventful recovery and was discharged a week later. The patient has recovered, is eating well, is regaining weight and has returned to Haldwani.
This case highlights that excellent outcomes can be achieved, even in patients with advanced colonic cancer, when managed by a dedicated team, willing to put a lot of extra eort into an individual patient. Firm resolve of the patients and their families and good treatment planning followed by a perfect execution by the treating team are needed when managing such complex patients and surgeries. Dr. Vivek added that less than 1000 such surgeries (combined Whipple's with Radical Colectomy) had been done worldwide, with very few having been done in India for colonic cancer.
He also added that they had done this procedure as part of an even more major surgery once earlier, too, 3 years ago, in a patient with a large retroperitoneal tumour, which needed the removal of additional organs. The case was also reported in the media, and the patient is now disease free and doing well. Such surgeries are being routinely performed by our team, whenever indicated, in patients with abdominal cancers, he added.
Gastrointestinal cancers impact the large intestine, GI tract and digestive system, including the oesophagus, stomach, small and large intestines, liver, gallbladder, pancreas, etc. Max Hospital, Vaishali, has a dedicated unit providing comprehensive cancer care for patients with these cancers. Amongst these cancers, colorectal cancer has the best outcomes with treatment stage-by-stage. Colorectal cancers originate from any part of the large intestine in the abdomen as ulcers or masses and can metastasise to the other parts, if not detected timely. Most patients with even widespread colorectal cancer live longer, productive lives with modern treatment, and some can even be cured.
