Hepato Biliary Surgery: A Patient’s Story
Damayanti Chandrakar, 56, from Raipur, Chhattisgarh had visited a physician with complaints of jaundice, pain in the abdomen and weight loss, over a one-month period. She was referred to Prof Tom Cherian, Head, Hepato Biliary Surgery and Liver Transplantation, CARE Hospitals Group for evaluation and management.
After admission and assessment, Damayanti was found to be severely hypertensive. She required oral anti-hypertensives for stabilizing her blood pressure. A biochemical investigation showed increased serum bilirubin (a measure of the severity of jaundice). Ultrasound and CT scans of the abdomen showed a malignant tumor in the common hepatic duct, with significant obstruction in the lumen and spreading to the surrounding lymph nodes.
This news was a deathblow to the patient as cholangiocarcinoma is an aggressive tumor and, if untreated, the average survival rate is around 6 months. It took almost a week for the patient and her family (her daughter is a doctor) to make up their mind and give their consent for surgery. Meanwhile, her total bilirubin had shot up 20 times the normal values. Hence, a pre-operative intervention (PTBD) was performed by an interventional radiologist in the right and left hepatic ductal system. Once the bilirubin dropped in a week’s time, she was taken for surgery.
Prof Tom Cherian and his team performed a 9-hour long operation for excision of the tumor along with the right lobe of the liver and the surrounding lymph nodes, before they joined a part of the intestine to the liver. Intra-operatively, the blood vessels supplying blood to the liver were shaved free of the tumor. An intra-operative frozen section biopsy confirmed that both the cut margins were free of the tumor.
Damayanti had a relatively uneventful post-op recovery, except for some fluctuation in her blood pressure and a partial lung collapse (mild right pleural effusion), due to build up of fluid in the lungs — a common occurrence in such surgeries. Both the issues were quickly and efficiently managed by a cross-sectional team, comprising a general physician, cardiologist, interventional radiologist and physiotherapist.
The final histopathological report confirmed it to be a hilar cholangiocarcinoma with RO resection (no evidence of microscopic disease at the cut margins). The 5-year survival rate of such a case is 45-50%, but without surgery it is zero, even with chemotherapy. The patient and the relatives were extremely relieved and thanked all the hospital staff profusely for their support and hard work throughout their hospital stay.
This is a good beginning to the CARE Hospitals’ new Department of Hepato Biliary Surgery and Liver Transplantation!