Surgeons at WVU Medicine performed West Virginia’s first liver explant for tumor resection and autologous liver transplantation – a very rare procedure that requires a multidisciplinary team of heart and liver transplant surgeons to care for a patient. The procedure is only available at a small number of academic medical centers in the United States.
The patient, Douglas “Mike” Logsdon, a 67-year-old man from Hyndman, Pa., Suffered from a very rare form of cancer called leiomyosarcoma. He sought treatment for mild side and back pain when his tumor was discovered through advanced testing at WVU Medicine.
The leiomyosarcoma was located on the inner wall of the Logsdon vena cava, the main vein bringing blood from the lower body to the heart. Vena cava are two large veins (large vessels) that return deoxygenated blood to the heart from the heart from the upper and lower parts of the body. The superior vena cava and inferior vena cava both flow into the right atrium of the heart. They are located slightly off-center, towards the right side of the body. In the lower body, the inferior vena cava runs behind and is attached to the liver. Logsdon’s tumor was located just below his heart and partially blocked the inferior vena cava, as it involved the back of the liver itself. There was no way to remove the tumor without removing the liver itself.
Complete excision of the tumor and restoration or rerouting of circulation required a unique collaboration of two highly specialized surgical teams from WVU Medicine. Wallis Marsh, MD, Roberto Lopez-Solis, MD, and Carl Schmidt, MD, liver surgeons with the WVU Cancer Institute, collaborated with Vinay Badhwar, MD, and Lawrence Wei, MD, cardiac surgeons with the WVU Heart and Vascular Institute , in an operation that lasted about nine hours.
Dr Badhwar placed Logsdon on the heart-lung machine, or cardiopulmonary bypass. Dr. Marsh removed all of the liver and the part of the inferior vena cava that contained the tumor (ex-vivo). With the liver out of the body and in ice, Drs. Marsh, Lopez-Solis, and Schmidt began ex-vivo removal of the tumor invading the back of the liver.
Meanwhile, Drs. Badhwar and Wei performed an operation to replace the lower vein in order to restore the ability of lower body blood to flow directly into the right side of the heart. Then the teams had to find a way to reconnect the special veins from the liver to the heart.
Hepatic veins are blood vessels that return oxygen-poor blood from the liver to the heart. However, much of the hepatic veins and surrounding tissue had to be removed to completely resect the tumor. So the two teams then collaborated to sew specially constructed grafts from the hepatic veins coming out of the liver and connected them directly into the heart. They then re-implanted the rest of the liver and Logsdon’s vessels in a procedure called autotransplantation.
There were no complications and the patient recovered very well. He was released on Wednesday, October 20, after only five days in the hospital.
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