A world-first procedure performed at Atrium Health has given new hope to patients with rare forms of hepatic cancers. Known as the Ex Vivo-ALPPS procedure, a 25-member team has combined two previously described methods of treatment in a groundbreaking new combined procedure. The Ex Vivo-ALPPS method pioneered at Atrium Health restores hope to liver cancer patients initially believed to be untreatable.

News | 23 days ago

First-in-World Procedure for Liver Cancer Restores Hope for Patients

A world-first procedure performed at Atrium Health has given hope to patients with rare forms of hepatic (liver) cancers. Known as the Ex Vivo-ALPPS procedure, a 25-member team has combined two previously described methods of treatment in a groundbreaking new combined procedure. The Ex Vivo-ALPPS method pioneered at Atrium Health restores hope to liver cancer patients initially believed to be untreatable. 

“I was dying and I didn’t know it.” 

Robin Jeter, a 38-year-old mother of five from Richburg, SC, had been feeling sick for weeks. After speaking with doctors and discovering that she was diabetic, she tried following doctors’ orders by making improvements to her lifestyle through diet and exercise. But as time progressed, her health was not improving. “I went almost four years without knowing what I had until I met Dr. Vrochides,” recalls Robin.

Dionisios Vrochides, MD, PhD, FACS and the team at Atrium Health’s Levine Cancer Institute was able to pinpoint the exact cause of Robin’s illness: Adenocarcinoma, a rare form of cancer that affects the liver, pancreas, and biliary system, which includes the gallbladder and bile ducts. Treatments of HPB cancers are incredibly complex and often require combinations of chemotherapy, radiation and surgery in order to see results.

When cancer cannot be treated, it’s often for one of two reasons: biological or technical. In cases of biology, a cancer has spread to other locations where it can no longer be treated with a curative intent. In other cases, the sheer technical challenge of addressing HPB cancers often leaves patients without an option for traditional surgery.

The Challenge of Removing Liver Cancers 

There are rare situations, in which, although cancer has “favorable” biology and can theoretically be addressed, technical hurdles may prevent surgeons from providing a chance of cure to a patient. According to Dr. Vrochides, when a patient has cancer in the liver that involves many adjacent major vessels, many centers deliberate that chemotherapy or radiation is an option that can prolong one’s life, but the disease is considered to be non-curable. “But if you can technically remove the tumor from where it is, including the affected vessels, they are become of disease” adds Dr. Vrochides. “An incurable patient due to a technical issue becomes potentially curable.”

Two options exist to treat these locally advanced liver cancers: i) one technique known as “Ex Vivo, in which the whole liver is extracted, cleared by the cancer on a “back-table” and then transplanted back to the patient.  ii) the other technique is called “ALPPS,” which splits the liver and leaves the organ to regenerate within the body. Both the Ex Vivo and ALPPS procedures remain uncommon. Dr. Vrochides notes that treatment for locally advanced liver cancers are “extremely rare, and you need the appropriate patient and biology of the cancer” In order to deploy a surgical treatment.

For patients afflicted with hepatic cancers whose treatment hurdle is technical, the HPB, cancer, and transplant teams at Atrium Health have carried out a groundbreaking procedure. Performed by a collaborative team of surgeons, including HPB specialist Dr. Vrochides, Atrium Health performed the world’s first Ex Vivo-ALPPS technique, which combines the two existing methods of surgical treatment. 

The World’s First Ex Vivo-ALPPS Procedure

“Ex Vivo has been performed by other groups over the last 30+ years,” says Dr. Vrochides. “ALPPS has been utilized in practice for approximately 7 years. But the Ex Vivo-ALPPS combination has never been done before.

Ex Vivo-APLPS requires a team of about 25 heath care professionals, first to to carry out the ALPPS component, so as for the healthy liver to grow to an acceptable size, and then the Ex Vivo component, which involves taking the entire liver out, removing the tumor and the afflicted vessels, and reconnecting residual blood vessels, in the form of an auto-transplantation. This innovative procedure is only possible for a small number of patients. Approximately one out of twenty of evaluated patients become eligible for the surgery.

But for those with rare forms of locally advance liver cancer, or those who have once been told that nothing could be done due to technical reasons, the Ex-Vivo-ALPPS procedure restores hope of treatment to those believed to be untreatable. “I shouldn’t have been here, but I’m here,” says Robin, who notes Dr. Vrochides and the surgical team at Levine Cancer Institute handled her treatment with delicacy and thoughtfulness. “When I met him, he let me know he cared. He really let me know that he cared, and he let my family know step by step, he made sure I was comfortable. I love Dr. Vrochides.”

Collaborative, Innovative Care

The Atrium Health teams that developed the Ex Vivo-ALPPS procedure highlights the importance and significance of collaborative care. Only with a team of experts focused on innovative treatment options, highly specialized surgeons, and a dedication to treat rare and complex diseases would such a procedure be possible. “If I didn’t do the surgery,” recalls Robin, “I wouldn’t have but a year to live.” Since receiving treatment, Robin remains cancer-free. 

“People say you’re a cancer survivor. No, I’m a cancer warrior,” says Robin. “That was a fight. They took me over and I couldn’t do anything but fight. You have to fight to live because all your insides are fighting against each other. That’s a war. You’re a warrior.”