That Ken Littrell’s six-hour surgery to remove more than half his liver was done via a minimally invasive laparoscopic procedure is a remarkable thing. The fortitude it took the UCHealth University of Colorado Hospital surgeon to attain the skills to pull off such a feat makes it more amazing yet.
Littrell, 59, had already noted flagging energy levels when, walking out of the gym one day in September 2016, he couldn’t keep up with his wife Teresa, “and she had just had her knee replaced,” he said. The Parker resident soon had a stage 4 colon cancer diagnosis.
In early October, Littrell had his ascending colon removed at a community hospital. But there was more work to be done. On a friend’s recommendation, he touched base with Christopher Lieu, MD, who directs the University of Colorado School of Medicine’s Colorectal Medical Oncology Program. Littrell’s case channeled into the GI Oncology Multidisciplinary Clinic, where a team of CU School of Medicine medical, radiation and surgical oncologists as well as radiologists and pathologists team up to craft care plans for tough cases like Littrell’s. Wells Messersmith, MD, took the lead, prescribing four rounds of chemotherapy, the goal being to shrink a threatening liver tumor to the point that surgeon Ana Gleisner, MD, PhD, could remove it.
That Gleisner is a GI oncology surgeon at UCH – or anywhere else, for that matter – is a testament to just how much can change when talent meets drive. Gleisner had already gone through medical school, a three-year surgery residency, a year of transplant-surgery fellowship and a PhD program. She was a practicing surgeon in her native Brazil. Her interest in medical research brought her to Johns Hopkins University, where she focused on surgical outcomes, co-authoring papers with, among others, Richard Schulick, MD, MBA, now chair of the CU School of Medicine’s Department of Surgery.
“I really fell in love with the oncology field,” Gleisner said. “It’s a team approach. That’s the only way you can get people to have the best outcomes – they’re complex decisions, and they require knowledge coming from several different fields, and I just loved having that kind of challenge and perspective.”
She has continued her surgical-outcomes research here, spearheading the development of a database detailing hundreds of surgery cases, the aim being to spot ways to improve patient care.
Into the lap
You might think a transplant surgeon could transition quickly to cancer surgery. In fact, it would take eight years. Gleisner would have to do a six-year surgical residency in the United States, then a two-year complex surgical oncology fellowship. She knew she would be again subjected to the grueling workloads such training involves. She did it anyway: the residency at Saint Louis University, the fellowship at the University of Pittsburgh Medical Center. When she finished in 2015, Schulick and Barish Edil, MD, helped bring her to Colorado, and, ultimately, to Ken Littrell.
In Pittsburgh, Gleisner had honed rare skills in major laparoscopic cancer surgery on the liver. Having been involved with many liver transplants and other open liver surgeries was an advantage, she said. Successful laparoscopy – in which the work is done through small incisions, guided by a camera on one probe and surgical instruments on others – demands a deep understanding of the underlying anatomy and experience with open procedures, she said. You might liken it to preparing dinner though a couple of keyholes in the kitchen door. Some cases are too complex to do this way, but if it’s possible, there are big benefits: on average, there’s 50 percent less morbidity, 30 percent less blood loss, and two days less time in the hospital, among others, Gleisner said.
In Littrell’s case, it was soon clear that one of the metastases was, as he put it, “really close to a major blood supply in the liver.” The team would have to remove 60 percent of the liver, Gleisner concluded. They would start laparoscopically, reserving the option of switching to open surgery midstream if she deemed it necessary.
“She made me feel real comfortable and was a real straight shooter. She laid out all the options and said, ‘This surgery is the best chance for a cure,’” Littrell said. “Nobody had ever used the word ‘cure’ with me.”
Gleisner is careful to balance the benefits of minimally invasive surgery with the overarching goal of removing any visible hint of cancer, she said, “because you can’t compromise the oncologic safety and outcomes because of the approach.” In simple terms, just because you can wield the hammer of laparoscopy does not make every GI cancer surgery a nail.
“Having the ability to do any procedure laparoscopic, open, or a combination of the two gives patients the most options,” Schulick explained.
Back in business
She performed the surgery on Feb. 8. It went well, Littrell said. Gleisner visited him daily in the surgical intensive care unit and then the inpatient oncology unit at UCH. He was back home eight days later. Two-and-a-half weeks after the surgery, Littrell was working part-time from home as a senior software engineer. A few days after that, he was in the office part-time – a quick return made possible in part, he said, by the small incisions involved in laparoscopy. His energy was slow in returning – not because of the cancer this time, but because his body was preoccupied with re-growing the bulk of his liver, which took about two months.
Edil, himself a surgeon with rare laparoscopic expertise and one of few in the United States capable of doing a laparoscopic Whipple procedure for pancreatic cancer patients, called the surgery, “one of the toughest liver operations to be done laparoscopically. It’s a huge feat for our program and our hospital.”
Littrell’s cancer care continues under Messersmith’s watch, in the form of follow-on chemotherapy to take out remnant cancer cells no surgeon can see. Both are hopeful that the term “cure” will indeed apply.
In addition to Gleisner’s surgical skills, Littrell said he appreciates how invested she was in his well-being.
“She’s just so caring and really took the time to engage with me on how I was feeling,” he said. “She was really great, and I think she’s a wonderful person.”