Transplant Surgeon Tomoaki Kato on his Most Difficult Case Removing a Tumor - Best Doctors 2010 -- New York

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My Toughest Case

Removing a Tumor by Taking Multiple Orga

the Body

Tomoaki Kato, Transplant Surgeon, NewYorkPresbyterian Hospital/Columbia University Medical Ce

By Jada Yuan

Published Jun 6, 2010 ShareThis

he patient was a 63- year-old woman who had a rare

malignancy called a leiomyosarcoma. Chemotherapy

worked a little, but radiation really didnt do anything. Her

only option was surgery, but she had been told her tumor
was inoperable, at least by conventional methods. The
tumor wasnt especially large; it was about as big as a
baseball. But it happened to be in a very bad location. It
was sitting on the abdominal aorta, the biggest artery of
the abdomen, and wrapping around two other major
arteries. Basically, the blood vessels that supply every
major abdominal organstomach, pancreas, spleen, liver,
small bowel, large bowelwere involved. Going to the
tumor directly wasnt possible because every one of those
organs was in the way. Even if you could get to the tumor,
there was no way to cut it out without cutting sections of
(Photo: Jono Rotman; Grooming by Bryan Lynde)

the arteries involved. That would mean cutting off the

blood supply to the attached organs, causing them to die.

As a transplant surgeon, I knew that organs can survive outside the body for up to ten hours before going
into a recipient. My idea was to use transplant techniques with this patient. Wed clamp the arteries and
take out her abdominal organs, and put them in a cold-preservation solution. Then wed cut out the
tumor in the arteries, reconstruct her blood vessels using synthetic materials, replace the organs, and
reconnect the arteries. It would be like an organ transplant with the same person as donor and recipient.
Ive done a number of multiple-organ transplants, but this exact surgery had never been done before. I
told the patient there would be unknown risks involved, and that the procedure would be very
dangerous. Because we would be disconnecting the abdominal aorta, which goes to the spine, there was
a chance of paralysis. Blood connections could leak or clot. What if you take all the organs out, then find
that you cant reconstruct the blood vessels?
The initial part of the surgery took six hours. We were trying to create a situation where the entire organ
block is up in the air, meaning all the connections are cut and its ready to move. First, I divided the
esophagus from the stomach. The large bowel had to be cut in the middle portion. Part of the colon came
out. After we cut the arteries, we moved the organ block into preservation solution on the back table.
Even though organs can survive in the ice box for up to ten hours, the patient cant survive without
organs for that long. Our assumption was probably six hours, but we didnt want to reach that point.

Transplant Surgeon Tomoaki Kato on his Most Difficult Case Removing a Tumor - Best Doctors 2010 -- New York Magazine

That was the final limit.

Altogether, we numbered seven surgeons and two anesthesiologists. The team on the back bench had the
organ block and was cutting out the tumor and building the grafts needed to reconnect the arteries to the
organs. I was working in the patients abdomen. She was lying there on the table under anesthesia, with
nothing in her body cavity. Im used to seeing the empty abdomen, but many surgeons, when they see it,
are in awe.
To get the tumor out, we had to remove four inches of vena cava and three inches of aorta, which we
replaced with more synthetic grafts. The organs were out for nineteen minutes. It took about an hour to
sew them back in. Altogether it took about two hours to reestablish blood flow. With all the reconnecting
we still had to dothe stomach to the esophagus, and the restthe total surgery took fifteen hours. She
went home in three weeks.

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