Chandigarh
12 August 2021
DIVYA AZAD
A six-month pregnant pancreatic cancer patient from Afghanistan was operated at Fortis Hospital, Vasant Kunj. Having been denied treatment in her native country, the patient was successfully treated by Dr. Amit Javed, Director, Gastrointestinal Oncology, Fortis Flt. Lt. Rajan Dhall Hospital, Vasant Kunj, New Delhi, along with his team. Both mother and the baby in her womb are fine. There are only a handful of reported Whipple’s surgeries done on pregnant women patients across the world and this is probably the first in India.
The patient (Fahima) was five and a half months pregnant when she was diagnosed with pancreatic cancer. The first major challenge was in making the diagnosis itself. This is because in pregnancy, abdominal discomfort, nausea, and vomiting are common and even jaundice may occur. The commonly used method to diagnose pancreatic cancer is CT scan of the abdomen which is avoided in pregnancy as it is harmful to the foetus. Once the diagnosis was made, early surgical management is of utmost importance. Waiting for the delivery could risk spread of the cancer. Advanced pregnancy made the surgery challenging. In addition, she could not undergo chemotherapy on account of her pregnancy. Cancers arising in the body or tail of the pancreas are removed by a distal pancreatectomy whereas those localized to the head of pancreas or those which arise from the lower bile duct, ampulla and second part of duodenum are removed by Whipple’s pancreaticoduodenectomy.
The surgery in this situation was difficult and posed a potential risk for both the mother and the baby. Additionally, her uterus was already quite large and above the umbilicus. It was already obscuring access to the pancreas (the surgical field). Keeping these challenges in mind, Dr Javed and his team prepared for the Whipple’s Surgery.
Dr Amit Javed said, “This was a major operation which required us to adopt a multi-disciplinary approach. Advanced ICU capabilities, post-operative care units and high-level anaesthesia teams were all working in sync together.The surgery took 4 hours. We were able to perform it without ‘moving the baby’ and the postoperative tests showed complete tumour removal and a healthy baby. Fahima had a smooth post-operative recovery and was discharged after seven days. In a standard Whipple’s operation, we remove the cancerous tumour together with the head of pancreas, remove part of the stomach, small intestine, gall bladder, bile duct, and lymph nodes and reattach the remaining organs (allowing for the normal digestion of food). This was a complex procedure considering that the cancerous area (in the pancreas) and the uterus were very close to one another. “All necessary measures were taken during the procedure to ensure complete cancer removal; the foetus was not harmed in any way and the mother remained safe.”
Fahima, the patient, said, “The Whipple surgery proved to be a lifeline for me. I was adamant that this pregnancy was very important to me. Dr Javed and his team gave me hope and it is because of their expertise, skill and faith that me and my baby are alive today. I will always be grateful and thankful to them for giving me a new lease of life and for saving my child.”
Dr. Rajeev Nayyar, Facility Director, Fortis Hospital Vasant Kunj said, “We routinely perform the Whipple’s operation at Fortis Hospital Vasant Kunj. Dr Amit Javed and his team has a significant expertise in performing this procedure by the latest laparoscopic technique with excellent results which results in less blood loss, a shorter hospital stays and a quicker recovery. For the first time in India, a pregnant patient has undergone the Whipple’s surgery successfully and we are extremely proud of our doctors for the same. The successful outcome of the surgery is a testimony to the excellent expertise and multidisciplinary care offered at our hospital. I congratulate the team of doctors for their commitment to world-class patient care even amidst the pandemic.”
