Surgeons at WVU Medicine performed the state’s first liver explant for tumor resection and liver autotransplant – a very rare procedure that requires a multi-disciplinary team of heart and liver transplant surgeons to care for one 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 from Hyndman, Pennsylvania, had a very rare form of cancer called a leiomyosarcoma. He sought care for mild pain in his side and back when his tumor was discovered through advanced testing at WVU Medicine.
The leiomyosarcoma was on the interior wall of Logsdon’s vena cava, the major vein bringing blood from the lower body to the heart. The venae cavae are two large veins (great 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 the inferior vena cava both empty into the right atrium of the heart. They are located slightly off-center, toward 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 immediately 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.
The complete excision of the tumor and the restoration or re-routing of the circulation required a unique collaboration of two highly specialized WVU Medicine surgical teams. 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, heart surgeons with the WVU Heart and Vascular Institute, in an operation that took approximately nine hours to complete.
Dr. Badhwar placed Logsdon on the heart-lung machine, or cardiopulmonary bypass. Dr. Marsh removed the entire liver and the portion 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 the ex-vivo removal of the tumor that was invading the back of the liver.
Meanwhile, Drs. Badhwar and Wei performed an operation to replace the inferior vena to restore the ability of blood from the lower body to drain directly into the right side of the heart. Then, the teams had to find a way to reconnect the special veins of the liver to the heart.
The hepatic veins are blood vessels that return low-oxygen blood from the liver back to the heart. However, a large portion of the hepatic veins and the surrounding tissue had to be removed to fully resect the tumor. So, both 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 Logsdon’s liver and vessels in a procedure called, autotransplantation.
There were no complications, and the patient has made an excellent recovery. He was discharged Wednesday, Oct. 20, after only five days in the hospital.