Mumbai doctors give two-year-old child new lease of life with complex liver surgery

Mumbai doctors at a city hospital have successfully performed a complex and extraordinary liver surgery on a twoyearold giving the child a new lease of lifeAphsa was diagnosed with an advanced liver cancer involving major blood vessels in and around the liver The cancer was inoperable by conventional surgery leading to the innovative operation led by Dr Abhishek Mathur with the collaborative expertise of Prof Darius Mirza Dr Pradnya Bendre Dr Shailesh Sable Dr Gayatri Munghate and Dr Saurin Dani turning what seemed like an impossible situation into a story of hopeAphsa who is a cheerful and lively child was diagnosed with a locally advanced hepatoblastoma by oncologist Dr Mudaliar after her mother noticed a swelling in her abdomen Hepatoblastomas represent one of the commonest liver cancers in children However when they are central in their location within the liver they can prove to be a difficult surgical challenge on account of the involvement of important blood vessels in and around the liverFollowing diagnosis initial chemotherapy led to some tumour reduction but conventional surgery was still not feasible due to the tumourrsquos location and its involvement of vital blood vessels Liver transplantation would have been the treatment of choice but the absence of a donor living or deceased organ during the short critical window following chemotherapy made this unavailable Despite shrinkage with chemotherapy the tumour still completely obstructed blood outflow from the liver necessitating total liver removal and extensive vessel reconstructions not possible by standard surgical approachesDr Mathur who is the chief division of Liver Transplant and Hepatobiliary Surgery at Bai Jerbai Wadia Hospital for Children explains ldquoThe babyrsquos liver was small weighing around 500 grams and we planned to take the liver out of the body intact This rare Exsitu out of the body surgical technique involves removal of the entire liver from the childrsquos body followed by cooling and preservation of the organ outside the body for 45 hours This approach gives unparalleled exposure and access to remove the tumouraffected liver and perform a meticulous reconstruction of the blood vessels Once completed the reconstructed remaining healthy liver segment is autotransplanted back into the body Despite these benefits this approach is also associated with higher perioperative morbidity and mortality rates on account of liver injury while it is out of the body To mitigate these risks we used the novel technique of exsitu oxygenated hypothermic machine preservation which perfuses and cools the liver outside the body resulting in reduced liver injuryrdquoHe further added ldquoThis method of exsitu surgery using oxygenated hypothermic machine perfusion is rarely described for liver cancer and to the best of our current knowledge never reported in children in this situation Ex situ surgeries are regularly performed at only a handful of specialized centers in North America and even at these advanced institutions the procedure is carried out just a few times each year due to its complexity and highly selective indications To give context to how rare this operation is the existing medical literature includes only one published adult case where ex situ surgery was combined with hypothermic machine perfusion To the best of our knowledge this has never been done in India We plan to publish our data and have it peer reviewed to determine whether this approach has been attempted anywhere else in the worldrdquoDescribing the operation Mirza professor of Surgery and mentor of Division Of Liver Transplant and Hepatobiliary Surgery said ldquoA highly coordinated effort was crucial to the success of the surgery After the removal of the entire liver two teams of surgeons worked in tandem While one team removed the tumour from the liver and reconstructed the healthy remaining liver while it was being preserved on the hypothermic machine the other team performed a complex reconstruction of the major blood vessels inside the childrsquos bodyrdquoDr Bendre head of Solid Organ Transplant and Head of Pediatric Surgery added ldquoAphsarsquos surgery greatly benefited by access to the perfusion machine which was generously provided free of charge by the ldquoDuraent Lifesciences ensuring that Aphsarsquos underprivileged family could take advantage of this lifesaving technologyldquoAphsarsquos surgery lasted 14 hours and the use of the hypothermic machine prevented her from suffering liver damage She made an excellent recovery with the vigilance of our anesthesia and intensive care teams and was moved out of the ICU within the first postoperative week and discharged home about a week later While Aphsa will require further chemotherapy and close surveillance for tumour recurrence rates which can reach 103037 in such advanced cases her parents are profoundly grateful for her renewed chance at life said Dr Abhishek MathurldquoWhen we were told how serious our childrsquos condition was our world collapsed Every day was filled with fear and we did not know if she would survive This innovative procedure was something we had never even heard of but it became our only hope Today seeing our daughter smile again and dream of a bright future feels nothing short of a miracle While she still has challenges ahead we will always be grateful to the doctors who gave her the chance at liferdquo said her elated father Saddam Hussain ShaikhAutotransplantation where a childrsquos own healthy organ is returned to the body after treatment can be a powerful lifesaving option turning medical innovation into hope for families At Bai Jerbai Wadia Childrenrsquos Hospital we remain deeply committed to bringing advanced medical technology and global expertise together to ensure that no child is denied a chance at liferdquo concluded Dr Minnie Bodhanwala CEO of the city hospital