MHH: Interdisciplinary surgical technique saves cancer patient

After an initially palliative cancer diagnosis, Susanne Viehmeyer, 62, has been given a second chance – thanks to interdisciplinary collaboration at Hannover Medical School (MHH) and a surgical technique that is probably the first of its kind in the world. Viehmeyer was diagnosed with bile duct cancer – after several examinations in various clinics, the tumor was considered inoperable, and a cure seemed impossible. “I was told that the only option was palliative, i.e., life-prolonging chemotherapy,” reports the patient, who wants to encourage other patients.

“Thanks to a colleague from Wolfsburg Hospital, the patient was presented to the Molecular Tumor Board (MTB) at the MHH at the end of 2023,” explains Dr. Anna Saborowski, senior physician at the Clinic for Gastroenterology, Hepatology, Infectiology and Endocrinology. As a result, the patient received personalized and targeted cancer treatment. She was also included in an innovative therapy as part of a study that significantly reduced the size of the tumor. The operation was also made possible by a new drug.

What was special about Viehmeyer's case was that the tumor had infiltrated all three large hepatic veins, which was previously considered inoperable. She had already tried various therapies, but unsuccessfully. A histological examination revealed that the tumor had been largely destroyed, but still contained individual vital cells. The decision whether an operation would be possible after all was made at the MHH together with gastroenterologists, oncologists, radiologists, radiotherapists, pathologists, and surgeons. For the treatment, the MHH team used techniques originally used in transplant surgery. First, the liver was divided and the blood circulation rerouted so that the healthy liver lobe could grow before the tumor-infected area was removed.

Separate circulation for the liver

Eight days later, the tumor and the diseased lobe of the liver were removed using a procedure that, according to the MHH, was the first of its kind in the world. Two separate circuits were created: The liver itself was flushed with the cold, oxygen-rich solution. This technique – organ perfusion – originates from transplantation medicine, but was used here for the first time in a patient's body. Meanwhile, ECMO (extracorporeal membrane oxygenation) ensured the patient's circulatory and oxygen supply.

The fact that the liver remained bloodless and thanks to the organ perfusion, the sensitive liver tissue could be protected and there was more time for tumor removal and reconstruction of the blood vessels. Not only the right and middle hepatic vein, but also a large part of the left hepatic vein, was removed and then sutured back to the great vena cava. “In this way, the malignant tumor originating from the bile ducts could be removed even though it had affected all three hepatic veins,” says the MHH. “We were only able to reconstruct a hepatic vein during the operation because the liver was drained of blood. Thanks to the controlled cooling and continuous oxygen supply, we had enough time to do this. Everything went smoothly,” explained Prof. Dr. Moritz Schmelzle, Director of the MHH Clinic for General, Visceral and Transplant Surgery and Head of the Transplant Center.

After the second operation, the patient had to stay on the ward for another seven days. She was then able to go home without taking any further medication. According to Schmelzle, most of the steps had already been carried out, but not in this combination.

Progress through networking and new possibilities

The idea of operating on a diseased organ outside the body had been around for some time, but was implemented in the body by separating the breeding circuit. According to the MHH, it goes back to Prof. Rudolf Pichlmayr, under whose leadership the MHH became one of the world's leading research centers for transplantation medicine in the 1980s. “Ms Viehmeier's treatment shows the progress we have made in systemic and surgical tumor therapy,” says Schmelzle. “As a certified liver center, we can still offer a chance of recovery even in cases that seem hopeless.” Viehmeier advises other patients not to give up and not to be satisfied with their first opinion.

(mack)