But the cancer came back in the spring of the following year. Once again, Dr. Shah didn’t give up — and nor did Sandy and Michelle. Instead, Sandy went in for another ablation, and another when the lesions returned several months afterward.
Then, in 2016, when Sandy had yet another recurrence, Dr. Shah began working with Dr. Karim J. Halazun, a liver transplant and hepatobiliary surgeon with the Liver Transplantation and Hepatobiliary Surgery program at NewYork-Presbyterian/Weill Cornell Medical Center, who had recently joined the staff.
Colorectal cancer is the fourth most common cancer diagnosed among adults in the U.S., and “about half of patients with colon cancer end up having metastases to the liver,” Dr. Halazun says. “And though chemotherapy is getting better, surgery is the only curative option.”
“We push the limits and take on cases that others might not take on,” Dr. Halazun adds. “Sometimes their cancers are just simply not operable. But when we can, we try our best to remove them.”
Sandy’s case proved to be difficult. The doctors had told him that his surgery would take five or six hours. It ended up taking several more, in part because scar tissue from Sandy’s previous surgeries made it more complicated to lift out his liver.
“His liver was very, very stuck to his diaphragm,” says Dr. Halazun. “It took two to three hours to free it up.”
Once Dr. Halazun had isolated the liver and could see it clearly, he realized that the entire right lobe needed to be removed.
“He had four large tumors on that side, many around the major veins, and an additional tumor on the left side that also needed to be removed,” Dr. Halazun says. He ended up removing 60 percent of the organ.
“Depending on the patient, it’s possible to remove 65 to 70 percent of a person’s liver and still have it regenerate,” explains Dr. Halazun. “Within six weeks, in a normal liver, the volume of the remaining liver doubles.”
With the right lobe removed, another surgeon came in and reconstructed Sandy’s abdominal wall to repair a gigantic hernia.
“It was an amazing feat,” Dr. Shah says of the daylong surgery. “For many, a liver resection can be completed within a few hours. When Dr. Halazun operated on Sandy, it took him several hours just to get to the liver. Then, he performed intra-operative imaging to figure out how much disease remained. At that point, Dr. Halazun began operating on Sandy’s liver. Sandy has an incredible will to fight.”
Michelle grew anxious when the surgery took longer than expected, but “when they came out, the surgical team was really optimistic,” she says. “Just knowing that the cancer was out of his body made me feel good.”
Sandy spent 12 days recovering in the hospital. All told, he had undergone a dozen major procedures, surgeries, and ablations. Once he returned home he was so weak that he had to learn to walk again.