India’s first ex-situ liver cancer surgery saves 3-year-old at Mumbai hospital

The patient, Apsha Shaikh, with her parents

In a landmark medical achievement, doctors at Mumbai's Bai Jerbai Wadia Hospital for Children have successfully performed India's first-ever ex-situ (out-of-body) liver cancer surgery with autotransplantation on a three-year-old child, offering new hope for children with otherwise inoperable liver cancers.

"Apsha Shaikh was just two years four and months old when her father Saadam and mother Haseena brought her to the hospital. She was diagnosed with advanced hepatoblastoma - one of the most common liver cancers in children. However, investigations revealed that the tumour was centrally located and involved major blood vessels in and around the liver, making conventional surgery impossible," said Dr Pradnya Bendre, head of solid organ transplant and paediatric surgery.

Nearly 70-80 per cent of the child's liver was cancer-affected. Pics/By Special Arrangement

The challenges

• Though chemotherapy reduced the tumour size and helped a small portion of healthy liver to increase in size, it continued to block critical blood outflow from the organ
• A liver transplant was considered, but the absence of a suitable donor during the narrow treatment window ruled out that option as her parents were not a match while a cadaver donor matching her blood group was not available
• To keep the child alive while the liver was out of the body for 4.5 hours
• Salvaging the smaller healthy liver and ensuring it stays suitable for the auto transplant
• Nearly 70-80 per cent of the cancer-affected portion was excised while the liver was preserved outside the body for 4.5 hours using an advanced oxygenated hypothermic machine perfusion system
• Meticulous reconstruction of the liver and veins that pump out blood from liver to the body
• Handling the tiny liver that weighed just 500gm

The surgery has given Aphsa a 70 per cent chance of living a healthy life. If she would not have been operated she would have lost her life within a few months.

Considering that liver is a regenerating organ, there are 30 per cent chances that the cancer would relapse.

3 years
Age of the patient at the time of surgery

16 hrs
Duration of the surgery

4.5 hrs
Time the liver was outside the body

Rs 15-20 lakh
Approximate cost of the operation at a private hospital

Rs 3 lakh
Rent of hypothermic machine per surgery

Pretext-4
Stage of liver cancer that the baby was diagnosed with.