A 4,000 Kilometre Journey for a Whipple
How a 68-year-old retired engineer from Tashkent, Uzbekistan, found curative pancreatic cancer surgery in Delhi — when home, Moscow and Istanbul had said no.
“They Told Me to Go Home and Be Comfortable”
When Mr. Bakhtiyor Karimov, a 68-year-old retired civil engineer, started turning yellow in early 2024, his family took him to the best hospital in Tashkent. The diagnosis came quickly — a tumour in the head of the pancreas pressing on the bile duct. The opinion came even quicker: “It is too risky at his age. We can only put a stent and manage symptoms.“
His son Otabek, who works as a software developer in Almaty, refused to accept that verdict. Over the next six weeks, he sent his father’s CT scans to surgeons in Moscow, Istanbul and Mumbai. Two declined to operate. One offered surgery at a cost the family could not contemplate. Then a colleague recommended Dr. Abhishek Aggarwal at BLK-Max in Delhi.
“I sent the scans on a Monday evening. By Wednesday morning Dr. Abhishek had personally reviewed them and joined a video call with us in Russian-English-Hindi mixed translation. He did not promise a miracle. He explained exactly what could be done, what the risks were, and what the cost would be. That honesty is why we boarded the flight.” — Otabek, son
Pre-operative Workup at BLK-Max
The family landed at Indira Gandhi International on a Sunday night and was at the GI Oncosurgery OPD on Monday morning. Within 96 hours, the international patient services team had completed:
- Triple-phase CT pancreas: 2.6 cm mass in the head of pancreas with a single suspicious peri-pancreatic node. No vascular involvement. Resectable disease.
- MRCP: Tight stricture at the lower bile duct.
- EUS-guided biopsy: Moderately differentiated adenocarcinoma.
- ERCP + biliary stenting: A 10 Fr plastic stent placed to relieve jaundice (bilirubin dropped from 14 mg/dl to 3 mg/dl over 10 days).
- Cardiac and nutritional optimisation: Pre-habilitation diet and chest physiotherapy for two weeks.
The multidisciplinary tumour board cleared him for an upfront Whipple procedure.
The Surgery — A Classical Open Whipple
On the day of surgery Dr. Aggarwal performed a classical open pancreaticoduodenectomy (Whipple procedure) — one of the most complex operations in abdominal surgery.
- Duration: 6 hours 40 minutes.
- Resection: Head of pancreas, duodenum, distal common bile duct, gall bladder, and a 5 cm cuff of jejunum. Standard lymphadenectomy yielded 22 nodes.
- Reconstruction: Pancreatico-jejunostomy (duct-to-mucosa, modified Blumgart technique), hepatico-jejunostomy and gastro-jejunostomy.
- Blood loss: 320 ml.
- Intraoperative frozen section: All margins clear.
The Recovery
The Whipple is notorious for its post-operative course — pancreatic leaks, delayed gastric emptying and infections are common. We employ a structured Enhanced Recovery After Surgery (ERAS) protocol that has reduced our average post-Whipple stay by nearly 30%.
- Day 1: Extubated in OT, shifted to GI HDU, started on sips of water.
- Day 3: Drain amylase trended down; soft liquid diet started.
- Day 5: Walking unassisted; semi-solid diet tolerated well.
- Day 8: Drains removed.
- Day 12: Discharged with a structured diet, pancreatic enzyme supplements and a follow-up plan coordinated with his physician in Tashkent.
Final Histopathology
- Moderately differentiated ductal adenocarcinoma of the pancreatic head
- Tumour size: 2.4 cm
- pT2N1 (1 of 22 nodes positive)
- All margins (pancreatic, bile duct, retroperitoneal) clear — R0 resection
- Perineural invasion present; no vascular invasion
Life After the Whipple
Mr. Karimov flew home to Tashkent two weeks after discharge. His adjuvant chemotherapy (six months of modified FOLFIRINOX) was administered locally, with our team coordinating the regimen and reviewing scans via video. Fourteen months on, he is back to gardening, walking 3 km daily, and has put on 7 kg. His tumour marker CA 19-9 has remained within normal range on all follow-up visits.
“In Tashkent they told me to prepare. In Delhi they prepared me — for surgery, for recovery, for life again. Rahmat (thank you), Dr. Abhishek. You did not just operate on my pancreas. You operated on my hope.” — Mr. Bakhtiyor Karimov
Dr. Aggarwal’s Reflection
“A Whipple at 68 frightens many surgeons — but age alone is not a contraindication. What matters is physiological reserve, careful pre-habilitation, a meticulous operation and a recovery pathway built around the patient. Mr. Karimov also shows what makes Indian healthcare special: world-class outcomes at a fraction of Western costs, with the personal warmth that international patients tell us they rarely find at home.”
Have You Been Told Your Pancreatic Tumour is “Inoperable”?
A second opinion can change the verdict. Dr. Abhishek Aggarwal offers paid video consultations for international and out-of-station patients.
Request a Second OpinionDisclaimer: Patient name has been changed and image used with informed written consent. Imdividual outcomes vary; results described are specific to this patient and do not represent a guarantee of similar results in other cases.