Rebagliati Hospital Expands Pancreatic Cancer Treatment with Advanced Surgical Techniques

At Hospital Nacional Edgardo Rebagliati Martins in Lima, the surgical team now tackles pancreatic cancer cases that would have been considered beyond reach just years ago. The shift came quietly, through accumulated advances in chemotherapy and the deliberate adoption of techniques that sound like science fiction but work in operating rooms: using electrical pulses to destroy tumor cells, then removing what remains with surgical precision that extends into the blood vessels themselves.

Dr. César Rodríguez Alegría, who leads the hospital's pancreas service, describes the brutal arithmetic of the disease. Seven out of ten patients arrive already carrying metastasis—cancer that has spread beyond the pancreas. Another fifth have tumors so entangled with surrounding tissue that surgery seems impossible. Only about two percent walk through the door as candidates for immediate operation. For decades, this meant palliative care, chemotherapy to buy time, and conversations about what could not be done.

Then the chemistry changed. Modern chemotherapy regimens began doing something unexpected: they could shrink tumors, or at least stop them from growing. This opened a door. When a tumor stabilizes under treatment but refuses to shrink further, doctors now deploy irreversible electroporation—a technique that delivers carefully calibrated electrical energy to tumor tissue, causing the cancer cells to rupture and die. It sounds abstract until you understand what it enables: the chance to operate on a tumor that has been held in place, weakened, made vulnerable.

When surgery becomes possible, the Rebagliati team performs what they call high-complexity resections. These are not simple tumor removals. The pancreas sits tangled with major blood vessels—the portal vein, the superior mesenteric artery. A complete resection means removing the tumor along with whatever portion of these vessels has been invaded, then reconstructing the vascular system so blood can flow again. The surgery requires a surgeon who understands not just oncology but vascular reconstruction, not just anatomy but the specific anatomy of this particular patient's particular tumor.

The work depends on collaboration that extends across the hospital. Oncologists design the chemotherapy. Interventional radiologists guide needles and catheters. Pathologists examine tissue in real time. Radiation specialists contribute their expertise. Gastroenterologists manage the digestive complications. This is not a single surgeon's triumph but a system working in concert, each specialist knowing their role and trusting the others to know theirs.

Leonor Noriega Ignacio, seventy-five years old, became one of these cases. She came to the hospital with jaundice—her skin and eyes yellowed because a tumor was blocking her bile duct. The obstruction that brought her in also revealed the cancer early enough that treatment could begin immediately. She moved through chemotherapy, through the electrical ablation, through surgery. When she spoke about her experience, she emphasized something that statistics cannot capture: the difference between being treated and being cared for. She felt confidence. The team made the process bearable. She expressed gratitude not just for survival but for how she was treated while fighting for it.

The hospital has positioned itself as Peru's national reference center for complex pancreatic cancer. This means patients from across the country now have access to techniques and expertise concentrated in one place. It means the two percent who might have been operable now includes some of the twenty percent with locally advanced disease, and perhaps some of the seventy percent with metastasis who respond well enough to chemotherapy to become surgical candidates. The numbers are still grim by any measure, but they are less grim than they were. In oncology, incremental improvements in survival and quality of life are not small victories. They are the victories that matter most.