In a rare and complex medical case, doctors at Dharamshila Narayana Superspeciality Hospital, Delhi, have successfully performed a life-saving surgery on a 65-year-old woman with a complicated surgical history, highlighting the growing capabilities of medical expertise and advanced cancer care in India.
It also offers hope to patients with a history of multiple surgeries, given that the woman had earlier undergone a major cancer surgery—an Ivor Lewis esophagectomy—six years ago for cancer of the food pipe. The procedure involves removal of the diseased esophagus and reconstruction using the stomach, which is repositioned into the chest to restore the passage of food. She had recovered well after that operation.
However, she was later diagnosed with a tumour in the lower part of the common bile duct. In most such cases, patients develop jaundice, which helps in early detection. In her case, however, the absence of this symptom made diagnosis more challenging and delayed identification of the disease.
Doctors said that the only curative option in such cases is a Whipple procedure (pancreaticoduodenectomy), considered one of the most complex surgeries in gastrointestinal cancer treatment. But the case was further complicated by her previous surgery.
“In a standard Whipple procedure, the gastroduodenal artery is divided. In this patient, however, that artery had become the main blood supply to the reconstructed stomach conduit from her earlier surgery,” explained Dr. Neeraj Goel, Director and Senior Consultant in GI Oncology and HPB Surgery, who led the surgical team for her treatment. “Cutting it would have risked loss of blood supply and severe complications.”
Faced with this challenge, Dr. Goel, along with his team, decided to modify the procedure and preserve the artery while removing the tumour.
The surgery was technically demanding due to altered anatomy and dense scar tissue from the earlier operation. Normal surgical landmarks were difficult to identify, requiring careful planning and precision at every step.
Despite these challenges, the team successfully performed the modified Whipple procedure without compromising the blood supply to the stomach. The patient recovered well after surgery, with no major complications reported.
Doctors said such cases are rarely attempted due to the high risks involved and the need for advanced expertise. The success of the procedure highlights the importance of individualised treatment planning, particularly in patients who have undergone earlier complex surgeries.
With improved survival rates in cancer care, doctors are increasingly encountering patients who require further treatment years after their initial surgery. “As more patients live longer after cancer, we are seeing a rise in cases where additional interventions are needed despite altered anatomy,” Dr. Goel said. The successful treatment offers hope to patients with a history of cancer surgeries, many of whom fear that further treatment may not be possible. Dr. Goel emphasised that timely diagnosis, right evaluation, and innovative surgical approaches can still provide effective solutions.
The hospital emphasised that this successful treatment reflects the advanced surgical care available at Dharamshila Narayana Superspeciality Hospital, Delhi, where specialised gastrointestinal and hepatopancreatobiliary procedures are performed with precision and expertise.
