Skilled surgeon transplants man's own liver back into his body during innovative cancer removal procedure
January 3, 2019
When Richard Vanderslice went to the hospital for a lung scan, he received surprising news: his doctors spotted a tumor on his liver, which had not yet presented any symptoms. The South Carolina-based urologist viewed the early-stage, happenstance diagnosis as "a huge blessing" and immediately sprang into action, searching for a surgeon to remove his cancer.
He saw several liver specialists around the country who all recommended similar approaches, attempting to cut out — or resect — the tumor. While not large, the tumor's hard-to-reach location near and involving several small and large blood vessels would make a resection surgery risky and its success uncertain.
I've had some unusual symptoms in my home state of South Carolina, and I went to the emergency room. And as part of the evaluation, they got a CAT scan of my chest to make sure I hadn't passed a blood clot up into my lung area. And that was fine, but they noted something that didn't look quite right.
So two days later, an MRI confirmed that I had a tumor in my liver that was, in all likelihood, a cancer.
So Richard was fortunate in that he was able to pick up the diagnosis of primary liver cancer relatively early in his course. It hadn't spread to the lymph nodes, hadn't spread outside of his liver into the lungs, for example.
He put forth taking the liver out completely to get better access to this tumor. This tumor in and of itself was not very large, but it was in a very tricky part of the liver, close to some very big and small blood vessels.
The first part was what I call the donor operation. We had to do skeletonized the liver as if we were going to take it out for transplant. Then came the second part of the operation, which was a resection part, which is what we did in the basin. It was an ex vivo liver resection.
So the liver now is outside of the body. The body is being maintained on a bypass pump. The liver is now taken in chilled at four degrees centigrade, almost freezing, to flush out the blood so that it doesn't clot. And then we resected the central tumor and all the blood vessels around it. And then we reconstructed it using Gore-Tex, which is a plastic.
And then the third part of the operation was doing a transplant. We had to put it back in. So it was really three operations rolled into one full day. And true to form, it actually worked exactly as we had planned.
The operating room team was great, the anesthesia group was great. Nursing was fabulous. I mean, I couldn't have said anything better or hope for a better outcome.
So we're optimistic that we have a good starting point. He may need some additional therapy, but you know, we'll decide that now that we have the tissue that we can send out for specific genomic analysis for mutation analysis. And then to individualized therapy for that tumor.
I'm glad I did it, and I feel like I've been cured at this point in time. I'm very optimistic. And I feel like my chances to be victorious with this situation were the best here at the University of Chicago. I don't think there's any other facility that I can think of that would've done a better job than John Fung and University of Chicago.
Instead, he took the advice of a physician friend and made an appointment to travel nearly 1,000 miles to see John Fung, MD, PhD, at the University of Chicago Medicine. Fung, a liver transplant surgeon, serves as the institution's chief of transplant surgery and the co-director of the Transplantation Institute.
Fung is a world-renowned researcher and a leading innovator in his field with more than 30 years of surgical experience. After meeting with Vanderslice, he proposed an innovative treatment for the problematic tumor: bench resection with autotransplantation. This type of surgery involves removing the liver from the body, cutting the cancer out while the organ is on a table in the operating room and then transplanting it back into the body. Vanderslice felt he would have the best chance for success with a liver autotransplant and immediately knew Fung was the surgeon to perform it.
"The beauty of medicine that makes it a special career for me is that it's a science and an art,"Vanderslice said. "You can teach one, but you can't teach the other... John has that. He has that special gift. Within five minutes of meeting him and talking with him, I knew he was my surgeon. I could put my complete and utter trust and faith in him, and he would take charge and get me through this challenging time."
Within five minutes of meeting [Dr. Fung] and talking with him, I knew he was my surgeon. I could put my complete and utter trust and faith in him.
The surgery took place in mid-November. A liver autotransplantation is essentially three operations rolled into one day, Fung said, and Vanderslice's procedure took almost 13 hours. During the first phase of the surgery, which required the use of a bypass machine to reroute blood that would normally course through the liver, Fung removed Vanderslice's liver from the body so he could see the tumor clearly. In the second phase, which involved cutting out the tumor in an iced basin, Fung and his team removed and rebuilt several crucial blood vessels using a plastic material. Doing this all outside of the body eliminated the potential for blood loss and ensured that Fung could remove the tumor completely. Finally, the repaired liver was reimplanted into Vanderslice, similar to a liver transplant.
An autotransplant can be performed on several types of organs, but only a handful of these surgeries take place nationwide each year, in part due to the skill and experience required from the surgeon and surgical team. Fung has performed five liver autotransplants in his career. Though uncommon, this well-researched approach was a great fit for Vanderslice's particular diagnosis.
"I couldn't have hoped for a better outcome," Fung said. "We're optimistic that we have a good starting point. Dr. Vanderslice may need some additional therapy, but we'll decide that now that we have the tissue we can send out for specific genomic and mutational analysis. Then, we can do individualized therapy for that tumor."
After the successful completion of his procedure, Vanderslice stayed in the hospital to recover for about two weeks. He and his wife were able to return to their lives in South Carolina shortly after Thanksgiving. And while he will continue to have his liver health monitored, he has no risk of his body rejecting the autotransplanted liver, unlike with a transplant involving an organ from a donor.
"I wouldn't say the operation was a walk in the park, but I'm glad I did it, and I feel like I've been cured at this point and time," Vanderslice said. "I feel like my chances to be victorious with this situation were the best here at the University of Chicago. I don't think there's any other facility that would have done a better job than Dr. John Fung and the University of Chicago."
John Fung, MD, PhD
With more than 30 years of experience, John Fung, MD, PhD, is a renowned leader in the field of organ transplantation, including liver, kidney, pancreas, islet and intestinal transplantation.Learn more about Dr. Fung