UC Health transplantation surgeons, in collaboration with the physicians of the University of Cincinnati Cancer Center, have performed the Greater Cincinnati region’s first liver transplantation surgery for isolated metastatic colon cancer. Only 10 procedures of this type have been performed in the U.S. to date.
The four-and-a-half-hour surgery was performed on Sunday, May 24 at the University of Cincinnati Medical Center, by Shimul Shah, MD, the James and Catherine Orr Endowed Chair in Liver Transplantation; chief of Solid Organ Transplantation; and professor of surgery for the University of Cincinnati College of Medicine, and Madison Cuffy, MD, UC Health transplant surgeon and assistant professor of surgery for the UC College of Medicine.
The UC Health Transplantation and the University of Cincinnati Cancer Center team collaborated to develop and implement the “liver transplantation for metastatic colorectal cancer surgical protocol” based on a successful program in Oslo, Norway. The Oslo group has reported one-, three- and five-year overall survival rates of 100%, 83% and 83% respectively.
The surgery consisted of standard transplantation techniques, which involved removal of the diseased liver of patient Paul Schueler, 56, of Williamsburg, Ohio, and replacing it with a healthy liver from a donor. The surgery is unique because it greatly increases the chance for extended survival for the patient.
“Colon cancer is one of the rare cancers that is still approached in a curative fashion after having spread to the liver, and due to the pattern of spread. In other words, the liver is the cancer’s ‘first stop,’ so to speak,” stated Jordan Kharofa, MD, UC Health radiation oncologist at the UC Cancer Center, and associate professor of radiation oncology for the UC College of Medicine.
According to Dr. Kharofa, for a select group of patients who are surviving with liver-only disease, are stable, are responding to all therapies but not eligible for conventional surgery, transplant surgery is the ultimate treatment – to remove the liver and take the cancer with it.
In the past, surgical resection of the liver has been the only curative treatment for patients in this life-threatening situation. However, only 20% of patients with colon cancer which has spread to the liver are candidates for resection surgery. As a result, only 58% of patients in this situation will survive up to five years. For those who are not eligible for resection surgery, 50% will die from their disease after just two years.
“Transplantation surgery has been proven to provide the best overall survival rate for patients with metastatic colon cancer that has moved into the liver,” said Dr. Quillin. “The estimated five-year survival is dramatically higher at 83%.”
Schueler’s clinical status matched the patient profile required to have the liver transplant while battling stage 4 colon cancer. Specifically, his original cancer site within the colon had metastasized, or spread, to his liver; however, had not spread to any other body organs such as the kidneys or lungs. UC Health transplant surgeons and physicians were able to act quickly and cohesively to bring the transplantation surgery to fruition.
Over the past eight years, Schueler received a variety of cancer treatments at UC Health, with his care managed by a multidisciplinary team of physician specialists. He spent considerable time undergoing several rounds of chemotherapy, liver surgeries, ablation to the liver, external radiation and liver-directed radiation therapy.
“When all of these treatment options failed to cure Schueler’s disease and no other surgical options were left, we made the decision to perform a liver transplant as it enabled us to definitively treat Schueler by removing and replacing the only known site of his metastatic disease – his liver,” stated Cutler Quillin, MD, UC Health transplantation surgeon and assistant professor of surgery within the Division of Transplantation for the UC College of Medicine.
UC Health’s new program is the result of forward-thinking physician specialists from the departments of transplant surgery, hepatology, surgical oncology, oncology, radiation oncology and interventional radiology.
“As the region’s only comprehensive organ transplant program for adults providing heart, kidney, liver and pancreas transplants, we are committed to providing access to lifesaving surgery and advanced medical care – even during the COVID-19 pandemic,” stated Richard P. Lofgren, MD, president and chief executive officer. “Our physicians and staff work tirelessly to find innovative solutions that advance healing and reduce suffering for the people in our region and from across the nation.”
About UC Health Transplant Services
The first organ transplant was performed at University of Cincinnati Medical Center in 1967. More than 50 years later, UC Health continues to innovate within the field of organ transplantation and to provide lifesaving care to those who need it most. In 2019, UC Health achieved a new record, with more than 320 people receiving much-needed organ transplants, marking the eighth consecutive year of growth. 2019 was also a groundbreaking year for clinical research at UC Health. Shimul Shah, MD, the James and Catherine Orr Endowed Chair in Liver Transplantation; chief of Solid Organ Transplantation; and professor of surgery for the University of Cincinnati College of Medicine, and his team, also performed the first liver transplant in the U.S. using a donor organ preserved through “mobile cold perfusion”. This technology, long used to preserve donor kidneys, was piloted at UC Medical Center and other transplant centers across the nation with promising results. It circulates a specially-formulated preservation solution through the donor organ prior to transplantation, rather than storing the donor organ on ice.