BACKGROUND: Some people diagnosed with cancer will get a second shock when they're told their cancer is inoperable. Inoperable can refer to the fact that the cancer has metastasized and spread through the blood and the body, or inoperable can mean the tumor is in a place that is impossible or too dangerous to remove; but, Tomoaki Kato, M.D., a transplant surgeon formerly with the University of Miami and now at Columbia University Medical Center in New York, N.Y., just led a surgical team through a world's first in the field of transplantation. While at the University of Miami, Dr. Kato and his team saved a woman's life by removing her "inoperable" cancer in an unconventional way.
REMOVING AN INOPERABLE TUMOR: Dr. Kato's patient, Brooke Zepp, came to him with a rare type of inoperable sarcoma called leiomyosarcoma. The tumor was buried deep in Zepp's abdomen and was wrapped around the aorta and six smaller arteries that supplied blood to her organs. It was impossible to remove the tumor with conventional surgical techniques without damaging the major intra-abdominal organs. Because the tumor could not be removed, Zepp was given six months to live. She sought a second opinion with Dr. Kato. "The only treatment that can cure the tumor was the removal," Dr. Kato told Ivanhoe. "What I told her after looking at the scan was, 'This is going to be a very dangerous surgery, but I think I can do it.'"
In a world's first, Dr. Kato and his transplant team removed six of Brooke's major organs simultaneously. They took out her stomach, pancreas, liver, spleen, small intestine and two-thirds of her large intestine. The organs were removed as a unit and put in an ice bath. While in the ice bath, a team of surgeons worked quickly to cut out the tumor that was buried within them. In the meantime, another team of surgeons worked on Brooke's empty abdominal cavity and replaced her cancerous blood vessels with artificial ones. For about 90 minutes, Brooke was essentially "organ-less." After 90 minutes, the organs were placed back inside Brooke's body and reconnected. "The major risk is really, after removing the tumor, if you cannot put it back together then you really have no organs," Dr. Kato explained. The entire procedure took 15 hours and nine surgeons to complete.
LIFE-SAVING: Brooke's recovery has been slow, but she's cancer-free and grateful to be alive. "This is somebody who had been told there's no way to survive and now she could be tumor-free," Dr. Kato said. "To achieve something like that ... it was really a great pleasure. It's the most exciting thing for us. I think there's a good chance this is a cure. This is the first time so it's hard to tell, but she's doing really well." Dr. Kato says this surgical approach has opened up avenues for treating other inoperable tumors, not just the type that Brooke had. He says it could literally give life to patients with inoperable tumors. "[One] type of inoperable [tumor] is more of a technical issue," he said. "The tumor cannot be removed because of the technical issue, but if it can be removed, the patient has a prognosis in survival potential and I think this type of surgery can apply to a lot of those situations."
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