Complex surgery performed on a 51-year-old patient to treat pancreatic cancer with portal vein invasion.

About the Patient and Condition

A 51-year-old Mahboob Rahman from Murshidabad, was diagnosed with advanced pancreatic adenocarcinoma. In 2019, he was suffering from jaundice, for which he underwent stenting to relieve the jaundice. In the hope of getting cured, he was taken to some other hospital in Hyderabad twice for stenting but each time would develop a block. He then underwent two more stenting surgeries in a hospital at Midnapore, West Bengal. Post this, he was brought to Apollo Gleneagles Hospitals, Kolkata, in the month of October 2020. Clinical examination revealed a mass in pancreatic head.

Case Scenario

Generally, jaundice can be reduced with stenting, but removal of the tumour is also necessary. Mr. Rahman, underwent a Whipple’s operation to remove the head of the pancreas along with a part of the stomach, the bile duct and the duodenum. In addition, his surgeons removed a segment of his damaged portal vein and replaced it with an artificial graft tube made of PTFE (polytetrafluoroethylene).

The patient recovered well and had uneventful post-operative period. He was discharged 6 days after surgery and is recuperating well at home.

Worldwide Scenario

The Whipple procedure (pancreaticoduodenectomy) is often considered for pancreatic cancer. In standard Whipples operation, the pancreas, duodenum, bile duct, small bowel and lymph nodes around this area are removed. But in Mr Rahman’s case the portal vein also had to be removed. Due to the complexity of the disease, earlier it would have been regarded incurable but now complex major surgery are often combined with chemotherapy to completely cure pancreatic cancers.

Expertise at Apollo Hospitals

Considering the patient’s condition, Dr. Ramdip Ray, Senior Consultant Liver Transplant Surgeon at the Institute of Gastro Sciences and Liver Transplant, Apollo Hospitals, Kolkata, said, “The challenge is reconstruction or rejoining of the resected vein. The reconstruction depends on how much length of the portal vein you are removing. If the length is very small you can just stitch that part and close it. For bigger gaps, you need to do end to end anastomosis (anastomosis is a surgical connection between two structures) – you remove a part of it and you join the upper and the lower end by mobilizing it. And sometimes if the length is too big, say 5 or 6 centimeters you cannot approximate the two ends together, so you have to put a patch in between the upper and the lower end. This patch can be a vein from the body itself if possible, or you can use an artificial graft to replace that vein. In this patient’s case, the natural vein was not available at that point of time. And so we had put an artificial graft (PTFE graft) replacing the portal vein.”

Apollo Gleneagles Hospitals, Kolkata, is the first hospital in Eastern India to perform such highly skilled surgery.

Apollo Hospitals – Touching Lives

When surgeons with expertise in pancreatic cancer surgery like Dr Sumit Gulati and Dr Supriyo Ghatak join hands with liver transplant surgeons like Dr Ramdip Ray, pancreatic cancers can be taken out along with a part of the portal vein without damaging the liver, offering real hope for patients with advanced cancer. Pancreatic cancer with portal vein invasion can also now be treated.

Dr. (Prof.) Mahesh Goenka, Director of the Institute of Gastrosciences at Apollo said, “COVID has made travel outside the state difficult for patients. Throughout these last 6 months, patients with very complex & advanced gastrointestinal diseases have received the most state of art treatment at centres like ours. I believe this is a clear assurance to the people of Bengal that Kolkata is right at the top of available expertise and facilities in medical care in India. Mr Rahman’s operation is testament to just that – case reports of a similar operation have not yet been published from anywhere in West Bengal earlier.”

Patient’s testimonial

The patient and his family was grateful to the entire team of Apollo Gleneagles Hospitals, Kolkata for ending his suffering and giving him a new lease of life.