First Whipple’s Surgery Of West Godavari District for Cancer Head of Pancreas

Telugu Newspaper dated 2007 reads as follows, “A team of surgeons and healthcare professionals, led by Dr Aswini Misro, is credited with a complex major surgery of advanced pancreatic cancer called Whippel’s Surgery……..”

In the West Godavari district at Asram Medical College, most of the patients in 2007 used to go to Hyderabad four major cancer surgeries. Patients with large bowel obstruction, obstructing cancer and other surgical emergencies had to not only undergo all the investigations at major cancer centres at Hyderabad, but the inconvenience of travel and cost were quite significant. We had received lot of requests from patients and carers to provide major gastrointestinal services at the facility. 

We got it out a baseline assessment of the resources, skill sets and infrastructure and decided to start advanced GI services. We started these services in unit number 4 of general surgery in 2006. Dr Aswini Misro was the unit in charge of Unit 4. We had the support of many senior surgeons. 

We started performing abdominal-perineal resection, low anterior resection, gastrectomy D2 and major bowel resections. The success with these major surgeries and patient recovery improved the confidence of the staff enormously. Slowly the staff where are also trained in stoma management, ICU care, enteral nutrition and total parenteral nutrition etc. 

Till that point, in 2007, older patients with the periampullary carcinoma of the pancreas or any patients with head of pancreas cancer had to be sent to Vijayawada for ERCP guided stenting. Subsequently, the patients were referred to the regional cancer centre at Hyderabad for further management. At that point about at the beginning of 2007, we had a referral for patients presenting with obstructive jaundice. As usual, we got the ERCP guidance stenting for this patient. As we discussed with the patient about referring to regional cancer centre at Hyderabad, the patient and carer shown their keenness to get operated locally as it will be convenient for them. 

After a few rounds of discussion, the patient looks determined, and we had our senior surgical team members who already had a discussion to finalise a plan for definite of surgical management of his condition at our facility. Our anaesthetic team were confident of anaesthesia and recovery of the patient. 

With all the plans and back ups in place, we set out the date for Whipple’s surgery and resection of the tumour located in the head of the pancreas, with a joint procedure involving three surgeons and two anaesthetists. The operation lasted for 7.5 hours. The blood loss was 450 ml. Dr Aswini Misro was the lead for the surgery whereas Dr Mazumdar was the assistant. Prof S Senapati was overall supervisor who stayed unscrubbed during the procedure. 

The patient made a functional recovery following surgery. The post-op recovery of the patient was met with the pancreatic fistula and leak. This was managed expectantly and the patient was discharged 42 days following admission. The post-operative histology of the resected specimen showed favourable cancer adenocarcinoma of the periampullary region of the pancreas. The patient came to the outpatient clinic for a 3 and 6 monthly follow up, and till that point she was doing well except issues with early satiety needing small frequent meal.

Dr Aswini Misro is specially thankful to Prof C Palanivelu for teaching him his way of carrying out the surgery.