«ONE GOAL — TO RECOVER. I HAD NO OTHER OPTION»

A 39-year-old resident of Vladivostok turned to P. Hertsen Moscow Oncology Research Institute – branch of the Federal State Budgetary Institution of the «National Medical Research Radiological Centre» of the Ministry of Health of the Russian Federation with stage 4 cancer. The pancreatic tumor had grown into the hepatic artery. Until recently, this diagnosis meant only one thing – palliative care.

«Up until last year, clinical guidelines clearly prohibited surgery to remove such tumors once the disease had spread to major vessels», says Vladimir Trifanov, Doctor of Medical Sciences and Head of the Center for Abdominal Surgery. «But with the development of neoadjuvant therapy — treatment using medications and radiation before surgery — the situation has changed significantly».

Viktor was one of those rare cases. Chemotherapy he received locally, along with a course of HIFU — a specialized method of targeting tumors with ultrasound — performed at the P. Hertsen MORI, halted the tumor’s growth. That gave hope to move forward.

«We perform pancreatic surgeries almost every day», says Viktor’s attending oncologist, Turon Mirzaev. «But removing and reconstructing a major artery — that was an extraordinary case».

A multidisciplinary team of abdominal and vascular surgeons — all part of the Radiological Centre’s staff — was formed following an oncological board decision. The specialists had to not only remove the tumor along with the pancreas, gallbladder, duodenum, and hepatic artery, but also replace the artery with a graft. The graft was a section of the patient’s own subcutaneous vein from his thigh, prepared by vascular surgeons Vladimir Iofik and Nikita Frantsev. This graft would act as a substitute for the hepatic artery.

The procedure was complicated by the fact that previous attempts to mobilize the tumor locally had caused a thrombosis in the artery, rendering it nearly nonfunctional.

«We managed to restore normal blood flow through the graft only on the third attempt», Dr. Trifanov explains. «We had to re-suture it three times before achieving the desired result».

The surgery lasted 12 hours. Postoperative monitoring using CT angiography and Doppler ultrasound confirmed that the graft was functioning and hepatic blood flow was good.

«The moment I regained consciousness, I asked to contact my parents», Viktor says with a smile as he prepares for discharge. «I had one goal — to recover. After all, I had no other option».

Going forward, Viktor will need to constantly monitor his blood sugar levels — a standard practice after pancreas removal — but insulin therapy is readily available throughout the country. In all other respects, he is returning to his normal life.