The world’s first “discarded liver” transplant combined with ALPPS for advanced liver cancer
China Health Trip takes you through the latest medical breakthroughs in China, showcasing the possibilities of advanced healthcare. Read on for more insights.
After undergoing 1 colon cancer resection, 28 chemotherapy sessions and 1 interventional chemotherapy session, Ms Chen’s (pseudonym) health was deteriorating, and her originally happy family was shrouded in gloom due to years of cancer treatment. Recently, an innovative surgical procedure by the liver surgery team of Zhongshan Hospital of Fudan University has rewritten the fate of this patient with liver metastasis from advanced colon cancer, and brought a long-lost smile and hope to this family.
In June 2024, the Department of Liver Surgery of Zhongshan Hospital, Fudan University has made a major breakthrough in the field of liver cancer diagnosis and treatment, and successfully performed the world’s first ‘abandoned liver’ liver transplantation combined with ALPPS (two-step hepatic resection with hepatic septum and portal vein ligation) on a 36-year-old patient with liver metastases from multiple colon cancers. This innovative surgery not only brings new hope to the patient, but also provides a new way to solve the problem of donor organ shortage.
In February last year, Ms Chen was diagnosed with liver metastasis from colon cancer, and her condition remained critical after 12 rounds of chemotherapy. in August, under the treatment of Professor Xu Jianmin’s team, Director of Colorectal Surgery at Sun Yat-sen Hospital, Ms Chen underwent a successful resection of the primary focus of her colon. This was followed by another round of 16 chemotherapy treatments and one interventional chemoembolisation treatment. However, by this time, the metastases all over the liver had gradually become resistant to chemotherapy drugs, and traditional treatments were ineffective. If she did not take effective treatment in time, she could only watch her condition deteriorate.
In the face of this problem, Zhongshan Hospital’s liver tumour surgery team decided to adopt a brand new surgical method – ‘abandoned liver’ liver transplantation combined with ALPPS after in-depth research. This innovative surgical method cleverly combines ‘abandoned liver’ liver transplantation with ALPPS technology, and achieves total hepatectomy within one week through a second operation, thus completely removing the tumour.
Preoperative preparation and surgical procedure
After strict ethical review and thorough preoperative preparation, under the guidance of Fan Jia, an academician of the Chinese Academy of Sciences, Professor Zhou Jian led the liver surgery team of Professor Huang Xiaowu, Professor Shi Yinghong, Professor Wang Xiaoying, Chief Physician Wang Zheng, Chief Physician Ding Zhenbin, Associate Chief Physician Xiao Yongsheng, Deputy Chief Physician He Yifeng, and Associate Chief Physician Song Kang, to successfully carry out this innovative surgical procedure for Ms. Chen.
The whole operation was divided into two stages: in the first stage, the surgeons precisely isolated the right and left halves of the patient’s liver and resected the left lobe of the diseased liver, which was full of 10 metastases; followed by a delicate transplantation of a discarded part of the left lobe of the liver (which had been ‘discarded and useless’ from a part of the left lobe of the liver that had been removed during the same period of resection of the benign tumour in the caudate lobe of the liver in order to ensure safety of the operation). After transplantation, the right branch of the portal vein of the diseased liver was carefully ligated. The implanted liver was so delicate that the surgical team had to precisely measure and regulate the blood flow and pressure in the left side of the portal vein to ensure that the second stage of the surgery went smoothly.
Postoperative recovery
Just one week after the surgery, Ms Chen’s implanted waste liver grew rapidly, increasing in size by about 70%, and the growing ‘waste liver’ was fully capable of performing the physiological functions of Ms Chen’s liver.
The surgical team immediately performed a second-stage operation to successfully remove the right side of the diseased liver remaining in Ms. Chen’s body. During the operation, the surgeons found that 23 metastatic tumours were hidden in this diseased liver!
With the support of Professor Miao Changhong, Director of Anaesthesiology, Dr Zhou Di, Associate Chief Physician, and nursing team including Nurse Ni Xiaoyun, Chief Nurse of the Operating Room, as well as Director Wang Ting, Associate Chief Physician Yang Liuxiao, and Attending Physician Huang Junfeng of the Liver Surgery Care Unit, the entire operation was completed successfully.
After the operation, Ms. Chen recovered well, and her tumour marker CEA dropped rapidly from the peak of more than 3,000 to a normal value of 2.9. She was discharged from the hospital 21 days after the operation after receiving the preventive chemotherapy formulated by Director Liu Tianshu of the Department of Medical Oncology and Director Xu Jianmin of the Department of Colorectal Surgery.
In the face of this miraculous transformation, Ms Chen said with emotion, ‘Thank you to the team of specialists at Zhongshan Hospital and the kind-hearted person who selflessly sacrificed his abandoned liver, it is you who gave me a new life!’
The significance of ALPPS
It is learnt that liver is one of the common metastatic sites of colorectal cancer. For many patients with liver metastases from colorectal cancer who are unable to undergo radical hepatectomy, liver transplantation has become a treatment modality that may bring about a survival benefit. ALPPS is a newly developed hepatectomy procedure in recent years for patients with too many or too large liver tumours and insufficient remaining liver volume after tumour resection, which significantly improves the surgical resection rate through a two-stage surgical operation.
According to Professor Zhou Jian, the successful implementation of this innovative ‘abandoned liver’ liver transplant + ALPPS provides a new liver donor option for liver transplantation for liver cancer patients, effectively breaking through the severe shortage of liver sources and bringing hope of cure to advanced liver cancer patients.
Under the leadership of Academician Fan Jia and Professor Zhou Jian, Sun Yat-sen Hospital performs more than 7,000 liver resections annually, making it the world’s largest liver surgery centre in terms of the number of liver surgeries, with an internationally leading 5-year survival rate for liver cancer. In some patients, benign liver tumours are increasing in size and are close to or encircling large blood vessels, so to ensure the safety of the surgery, it is necessary to resect part of the normal hepatic lobe tumours, the so-called ‘pulling out the carrot and bringing out the mud’, and part of the resected liver lobe is either thrown away as medical wastes or used only for basic research. If these ‘discarded’ livers can be turned into treasures, they are expected to be used as liver donor for transplantation to cure diseases and save people’s lives.
At present, China’s liver transplantation is still very scarce, Zhongshan Hospital has successfully performed dozens of cases of ‘discarded liver’ liver transplantation, saving the lives of patients with advanced liver disease who are anxiously waiting for liver transplantation.
The world’s first “discarded liver” transplant combined with ALPPS for advanced liver cancer
China Health Trip takes you through the latest medical breakthroughs in China, showcasing the possibilities of advanced healthcare. Read on for more insights.
After undergoing 1 colon cancer resection, 28 chemotherapy sessions and 1 interventional chemotherapy session, Ms Chen’s (pseudonym) health was deteriorating, and her originally happy family was shrouded in gloom due to years of cancer treatment. Recently, an innovative surgical procedure by the liver surgery team of Zhongshan Hospital of Fudan University has rewritten the fate of this patient with liver metastasis from advanced colon cancer, and brought a long-lost smile and hope to this family.
In June 2024, the Department of Liver Surgery of Zhongshan Hospital, Fudan University has made a major breakthrough in the field of liver cancer diagnosis and treatment, and successfully performed the world’s first ‘abandoned liver’ liver transplantation combined with ALPPS (two-step hepatic resection with hepatic septum and portal vein ligation) on a 36-year-old patient with liver metastases from multiple colon cancers. This innovative surgery not only brings new hope to the patient, but also provides a new way to solve the problem of donor organ shortage.
In February last year, Ms Chen was diagnosed with liver metastasis from colon cancer, and her condition remained critical after 12 rounds of chemotherapy. in August, under the treatment of Professor Xu Jianmin’s team, Director of Colorectal Surgery at Sun Yat-sen Hospital, Ms Chen underwent a successful resection of the primary focus of her colon. This was followed by another round of 16 chemotherapy treatments and one interventional chemoembolisation treatment. However, by this time, the metastases all over the liver had gradually become resistant to chemotherapy drugs, and traditional treatments were ineffective. If she did not take effective treatment in time, she could only watch her condition deteriorate.
In the face of this problem, Zhongshan Hospital’s liver tumour surgery team decided to adopt a brand new surgical method – ‘abandoned liver’ liver transplantation combined with ALPPS after in-depth research. This innovative surgical method cleverly combines ‘abandoned liver’ liver transplantation with ALPPS technology, and achieves total hepatectomy within one week through a second operation, thus completely removing the tumour.
Preoperative preparation and surgical procedure
After strict ethical review and thorough preoperative preparation, under the guidance of Fan Jia, an academician of the Chinese Academy of Sciences, Professor Zhou Jian led the liver surgery team of Professor Huang Xiaowu, Professor Shi Yinghong, Professor Wang Xiaoying, Chief Physician Wang Zheng, Chief Physician Ding Zhenbin, Associate Chief Physician Xiao Yongsheng, Deputy Chief Physician He Yifeng, and Associate Chief Physician Song Kang, to successfully carry out this innovative surgical procedure for Ms. Chen.
The whole operation was divided into two stages: in the first stage, the surgeons precisely isolated the right and left halves of the patient’s liver and resected the left lobe of the diseased liver, which was full of 10 metastases; followed by a delicate transplantation of a discarded part of the left lobe of the liver (which had been ‘discarded and useless’ from a part of the left lobe of the liver that had been removed during the same period of resection of the benign tumour in the caudate lobe of the liver in order to ensure safety of the operation). After transplantation, the right branch of the portal vein of the diseased liver was carefully ligated. The implanted liver was so delicate that the surgical team had to precisely measure and regulate the blood flow and pressure in the left side of the portal vein to ensure that the second stage of the surgery went smoothly.
Postoperative recovery
Just one week after the surgery, Ms Chen’s implanted waste liver grew rapidly, increasing in size by about 70%, and the growing ‘waste liver’ was fully capable of performing the physiological functions of Ms Chen’s liver.
The surgical team immediately performed a second-stage operation to successfully remove the right side of the diseased liver remaining in Ms. Chen’s body. During the operation, the surgeons found that 23 metastatic tumours were hidden in this diseased liver!
With the support of Professor Miao Changhong, Director of Anaesthesiology, Dr Zhou Di, Associate Chief Physician, and nursing team including Nurse Ni Xiaoyun, Chief Nurse of the Operating Room, as well as Director Wang Ting, Associate Chief Physician Yang Liuxiao, and Attending Physician Huang Junfeng of the Liver Surgery Care Unit, the entire operation was completed successfully.
After the operation, Ms. Chen recovered well, and her tumour marker CEA dropped rapidly from the peak of more than 3,000 to a normal value of 2.9. She was discharged from the hospital 21 days after the operation after receiving the preventive chemotherapy formulated by Director Liu Tianshu of the Department of Medical Oncology and Director Xu Jianmin of the Department of Colorectal Surgery.
In the face of this miraculous transformation, Ms Chen said with emotion, ‘Thank you to the team of specialists at Zhongshan Hospital and the kind-hearted person who selflessly sacrificed his abandoned liver, it is you who gave me a new life!’
The significance of ALPPS
It is learnt that liver is one of the common metastatic sites of colorectal cancer. For many patients with liver metastases from colorectal cancer who are unable to undergo radical hepatectomy, liver transplantation has become a treatment modality that may bring about a survival benefit. ALPPS is a newly developed hepatectomy procedure in recent years for patients with too many or too large liver tumours and insufficient remaining liver volume after tumour resection, which significantly improves the surgical resection rate through a two-stage surgical operation.
According to Professor Zhou Jian, the successful implementation of this innovative ‘abandoned liver’ liver transplant + ALPPS provides a new liver donor option for liver transplantation for liver cancer patients, effectively breaking through the severe shortage of liver sources and bringing hope of cure to advanced liver cancer patients.
Under the leadership of Academician Fan Jia and Professor Zhou Jian, Sun Yat-sen Hospital performs more than 7,000 liver resections annually, making it the world’s largest liver surgery centre in terms of the number of liver surgeries, with an internationally leading 5-year survival rate for liver cancer. In some patients, benign liver tumours are increasing in size and are close to or encircling large blood vessels, so to ensure the safety of the surgery, it is necessary to resect part of the normal hepatic lobe tumours, the so-called ‘pulling out the carrot and bringing out the mud’, and part of the resected liver lobe is either thrown away as medical wastes or used only for basic research. If these ‘discarded’ livers can be turned into treasures, they are expected to be used as liver donor for transplantation to cure diseases and save people’s lives.
At present, China’s liver transplantation is still very scarce, Zhongshan Hospital has successfully performed dozens of cases of ‘discarded liver’ liver transplantation, saving the lives of patients with advanced liver disease who are anxiously waiting for liver transplantation.
