In a 15-hour operation, surgeons in the US used transplant surgery to remove and replace multiple abdominal organs so they could reach and cut out a tumour in a female patient who had a rare form of cancer.

The team of surgeons and their patient, 63-year old Brooke Zepp, a real estate agent from Pompano Beach, Broward County, Florida, held a press conference at the University of Miami/Jackson Medical Center, also in Florida, where they showed a video of the operation and discussed the procedure with reporters.

Lead surgeon Dr Tomoaki Kato, a transplant specialist, told reports that this was a new and unique approach. He and his team were already experienced at taking multiple organs out of one person and putting them into another person, but this was the first time they had put the organs back into the same person:

“It is very risky and definitely one of the most challenging surgeries of my career,” Kato told the press, reported WebMD.

He told reporters that it was thanks to the hospital’s track record with transplants that they were able to perform the procedure. He said during the last ten years doctors had learned a lot about how long people can survive without certain organs, and also how long the organs can survive and be kept working outside of the body.

Zepp had a rare type of tumour, called a leiomyosarcoma, which affects smooth muscle. In her case the tumour was deep inside her abdomen, wrapped around her aorta (the largest artery in the human body, attached to the heart) and two other arteries that supply blood to the stomach, liver, spleen, pancreas, small intestine and part of the large intestine.

Zepp had already been through chemotherapy and radiation treatment but neither had been successful and the cancer had persisted.

If the surgeons had tried to remove the tumour in the conventional way it would have damaged those organs, explained Kato. In most cases, the tumour would have been classed as inoperable.

According to the New York Times, the tumour was about the size of a lemon. Director of the hospital’s Transplant Institute and a member of the surgical team, Dr Andreas Tzakis told reporters:

“It wasn’t so big, but it was in a very strategic location.”

He explained they had to remove everything in the patient’s abdomen (these organs were kept cool while they performed the excision, added Kato), in order to reach the tumour, which they cut out quickly, together with the blood vessels that were attached to it.

Then the surgeons replaced some of the removed sections of artery with white Gore-Tex tubes and proceeded to reimplant the removed organs back into Zepp’s abdomen. The removed organs were outside of the body for about 90 minutes, reported the New York Times, describing their appearance on the video as sitting in a turkey pan, “sloshing in cool water, like leftover soup”.

This was the most difficult part of the whole procedure, Kato told WebMD, because after removing the organs they had to make sure they could put them back in again, without damaging them. He said no anti-rejection drugs were needed because the patient was receiving her own organs back again; they were not from another donor.

The patient is making a good recovery, said Kato, “she is considered cured at this point, but only time will prove its long-term efficacy,” he added.

Zepp appeared to be emotional and “held back tears”, said the WebMD report, as she and her doctors watched the video. She told reporters she could not believe it was her, and she was glad she had a good anesthesiologist.

The surgeons hope their success will open the door to other similar operations to remove inaccessible tumours in the abdomen.

Sources: New York Times, WebMD.

Written by: Catharine Paddock, PhD