Singapore performs first living donor liver transplant in stage 4 colorectal cancer patient

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SINGAPORE: It started with abdominal pain and diarrhea for Ms. Lim Gek Meng. Before long, a colonoscopy showed she had stage four colon cancer, which had spread extensively to her liver.

“It’s the fourth stage…so that means I’m going to die soon. I was very scared. Then I asked the doctors how much longer I had,” said Mdm Lim, 61, who talked about her consultation with doctors in 2020 when told about her terminal condition.

Two years later, Mdm Lim is cancer-free, after her son donated part of his liver to her in the first such transplant for a patient with extensive metastatic cancer in Singapore.

In July, Mdm Lim received a liver transplant from her son, Mr Goh Jun Le. A multidisciplinary team including pathologists, radiologists, surgeons, hepatologists and oncologists from the National University Health System (NUHS) was involved.

The liver transplant was her only hope after doctors discovered they couldn’t surgically remove cancer cells from her liver, because that would risk losing too much of the vital organ.

Conventionally, patients such as Mdm Lim undergo chemotherapy to control and prevent the spread of the disease and would have no further treatment options.

BREAKTHROUGH FOR OTHER PATIENTS

Liver transplants were previously not recommended for stage four cancer patients because a suppressed immune system as a result of the procedure can increase the risk of a cancer relapse. However, studies over the past two decades have shown that transplantation is possible with careful patient selection.

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To facilitate such a transplant, NUHS, along with international experts, has developed patient management guidelines with 44 criteria to help define specific patient profiles appropriate for the procedure, as well as testing for treatment during the transplant and aftercare. .

Eligible patients include, for example, colon cancer patients whose disease has spread only to the liver that cannot be operated on beforehand and is responding well to chemotherapy, said associate professor Glenn Bonney, a consultant in the Department of Liver and Pancreatic Surgery at the National University Hospital (NUH).

He added that the cut-off age for transplants is generally 70.

More than 50 medical professionals were needed to assess Mdm Lim’s condition, perform treatment procedures and provide follow-up care.

Liver transplant increases a person’s chances of survival by at least another five years, from less than 20 percent to more than 60 percent, and the breakthrough has paved the way for other suitable candidates to undergo the procedure.

Colorectal cancer is the most common cancer in men and the second most common cancer in women in Singapore. More than 50 percent of patients develop metastases — the spread of cancer cells — to the liver, according to the National University Cancer Institute Singapore (NCIS).

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“The colon gets all the nutrition and food goes through the colon, and there’s a very important blood vessel that carries that digested food through the blood to the liver,” said Assoc Prof Bonney.

“When colon cancer appears in the colon, the cells are able to move through that blood vessel to the liver and therefore by far the most common way colon cancer spreads is to the liver.”

Assoc Prof Bonney said he felt privileged to be part of Mdm Lim’s recovery process and to be part of the team leading the first liver transplant in Singapore and the region in a stage four cancer patient.

“I feel really privileged to be able to work in a system that can generate that kind of care, to finally reach a stage where after those two years… to have our patient transplanted, to be there with the whole team in the intensive care unit. care, when she was fully awake after the transplant to tell her, ‘Mdm Lim, today you don’t have cancer,’ he said.

CARE FOR MDM LIM

Assoc Prof Bonney said Mdm Lim’s aftercare is of two priorities – first to ensure there are no episodes of rejection to her liver, and second to ensure there is no relapse due to a weakened immune system .

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“I have to do a follow-up every week, but I’m lucky enough to even be able to do a follow-up every week,” said Mdm Lim in Mandarin. “I want to live. I want to beat cancer. The most important thing is that I live.”

Her son, Mr Goh, said that when the opportunity presented itself – his liver was a match and could be transplanted into Mdm Lim – he thought, “Let me go for it. Because she is my mother and I want to help her.”

“When I came out of the operating room, when I woke up, I was relieved to find that the surgery had gone well and then, over the weeks, that her liver – my liver that was transplanted into her – was still good. works,” said Mr Goh.

He was relieved and happy, he added.

“He’s very brave,” Mdm Lim said of her son. “When he said yes to donating his liver to me, I was very encouraged. I gave him life and now he has given me mine.”

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