Unprecedented Surgery Performed at UM/JMH Transplant Institute

3/25/2008

Ten months ago, 63-year-old Brooke Zepp was told by her doctors that the tumor buried deep in her abdomen was inoperable. They gave her six months to live. Today she will be discharged from Jackson Memorial Hospital after a history-making 15-hour surgery led by Tomoaki Kato, M.D., professor of clinical surgery at the Miller School.

Zepp's two-inch tumor was located deep in her abdomen and wrapped around the aorta and the base of the celiac and superior-mesenteric arteries. These arteries supply blood to most intra-abdominal organs stomach, pancreas, liver, spleen, small intestine and two-thirds of the large intestine.

After her initial diagnosis of leiomyosarcoma, a rare form of cancer, Zepp underwent a combination of chemotherapy and radiation at other medical centers, but the treatments failed. She then turned to UM/Jackson, where the surgical team at the Transplant Institute offered a novel approach, one believed to be the first of its type in the world.

"A friend told me, 'if anyone in the world can do this, it is Dr. Kato,'" Zepp recalled at a news conference held at JMH almost three weeks after her surgery. "He spent five or six hours with me giving me the confidence to go through with it."

The procedure--performed by a team of seven surgeons, two anesthesiologists and eight nurses--required removing six intra-abdominal organs (which were chilled and preserved outside the patient's body), partially removing several arteries, replacing many blood vessels with artificial ones made from Gore-Tex, removing the tumor, and re-implanting the organs.

"The concept developed over time," said Andreas Tzakis, M.D., director of the UM/JMH Transplant Institute. "Weve done pieces of the puzzle, but not the entire thing at one time. She was the perfect patient for this surgery because she had a locally invasive tumor. It's not that the tumor was so big that made the procedure complex, but that it was located in the middle of everything."

Zepp was kept stable by assistant professor anesthesiology Yehuda Raveh, M.D., while Dr. Kato repaired the arteries and reconstructed the blood vessels, and Dr. Tzakis, stationed at the "back table," removed the tumor and prepared the organs to be replaced. Additional Miller School physicians supported the procedure in their respective specialities, including Maria Abreu, M.D., chief of the Division of Gastroenterology, Paul Martin, M.D., chief of the Division of Hepatology, and professor of surgery Danny Sleeman, M.D.

"As far as we know, the margins are clear and cancer is removed," said Dr. Kato.

News of Zepp's ground-breaking surgery traveled around the world, with coverage by media outlets including Reuters, CNN, ABC News, CBS Evening News, The New York Times, and Good Morning America, Health Day, WebMD, The Miami Herald and The South Florida Sun-Sentinel.

When asked by a reporter why she took the risk of being the first patient for this monumental surgery, Zepp said, "Somebody had to be first, and I wanted to take a chance on living. It was my only hope." She remains optimistic about a cancer-free future. "I invited Dr. Kato to my 100th birthday," she said.