One operation combined liver transplantation and pancreaticoduodenectomy to treat a 4-year-old child

Photo by Wang Qian

Tianjin North News: Recently, the Children’s Organ Transplantation Department of Tianjin First Central Hospital and the Department of Hepatobiliary Surgery successfully performed liver transplantation and pancreaticoduodenectomy for a 4-year-old child. The child is the youngest known operator of this combined operation in the country.

4-year-old Xiaoxin (pseudonym) developed abdominal distension and abdominal pain a year and a half ago, and was diagnosed as “pancreatoblastoma with liver metastasis” after medical examination. After 6 rounds of chemotherapy, her condition was not significantly controlled . Because the disease is relatively rare and the operation is difficult, the parents took Xiaoxin to seek medical treatment, but they were told that they could not be treated with surgery. A few days ago, a family of three came to our city’s No. 1 Central Hospital and sought help from Gao Wei, director of the Children’s Organ Transplantation Department.

According to Gao Wei, the pancreatoblastoma suffered by Xiaoxin is a rare low-grade malignant tumor of the pancreas. Compared with adults, it is more common in children, so it is also called childhood pancreatic cancer. Treatment of liver metastases is extremely difficult. After systematic examination, it was found that the pancreatic tumor of the small core occurred in the pancreatic head, and was associated with extensive liver metastases. Conventional surgical resection and chemotherapy were difficult to cure. Liver transplantation combined with pancreaticoduodenectomy became the only treatment option. Surgery is difficult and risky. According to the search of the hospital, there are currently no more than 10 cases of this combined operation reported worldwide.

The vice president of the hospital, Zhang Yamin, said that to remove the tumor at the head of the small core of the pancreas, the head of the pancreas, the duodenum, the distal stomach and the beginning of the jejunum need to be removed, and then corresponding fit. The difficulty is that the anastomosis between the stomach, gallbladder, and pancreas must be “seamless”, otherwise the use of immunosuppressants and hormones after liver transplantation will increase the risk of infection.

On the day of the operation, Gao Wei’s team first completed the liver transplant for Xiaoxin, and Zhang Yamin led the hepatobiliary surgery team to relay the pancreaticoduodenectomy. The entire combined operation was successfully completed in 10 hours. After 3 days of surgical ICU treatment, Xiaoxin was successfully transferred back to the general ward. At present, Xiaoxin’s physical indicators have recovered well and will continue to receive chemotherapy in the later stage. (Sun Chang, editor of Jinyun News)