Lung is operated outside the body and then placed back – 07/12/2023 – Equilibrium and Health

Doorman Oswaldo de Jesus Santos, aged 68, was working normally on a Saturday in 2020 when he felt a severe pain in his chest.

As the discomfort did not go away, he decided to go to the emergency room the next day, where he was diagnosed with tuberculosis.

Not noticing an improvement in symptoms after going through the initial treatment, Santos scheduled a new appointment, underwent tests and received the news: the origin of the problem, in fact, was lung cancer.

Born in Itagibá, Bahia, and living in São Paulo for 50 years, Santos says that the discovery of the tumor did not immediately cause fear. “I immediately thought: if there’s a way, we’ll get the ‘bug’ out. And, if not, I’ll go to the hole anyway”, he says, in a joking tone.

Even with his apparent serenity and abnegation, Santos could not have imagined that, a few months after the news broke, he would be one of only three Brazilians to undergo an innovative and little-known surgery in the country.

In summary, his right lung, which was affected by the disease, was completely removed from the body and operated on a separate operating table, where the tumor masses were removed.

A few hours later, that same organ was reimplanted back into the doorman’s chest — where it continues to function to this day.

This operation —known as an autotransplantation— allowed Santos’ disease to be brought under control.

Three years after the procedure, during which he continued to undergo regular follow-up and examinations, there is still no evidence of relapses or that the tumor has returned.

But this method, of course, is not indicated for all patients with lung cancer – and requires extensive evaluation by the medical team before being performed.

oncology and transplantation

Thoracic surgeon Marcos Samano, from Rede D’Or São Luiz, in São Paulo, was responsible for the first three lung autotransplants in Brazil. He is a professor of thoracic surgery at the Faculty of Medicine of the University of São Paulo (FMUSP).

Samano says he read articles about this type of surgery about 12 years ago. “It combines two different experiences and medical specialties: oncology and the area of ​​transplants”, comments the specialist.

Of the three surgeries performed by Samano so far, two took place through the Unified Health System (SUS).

According to him, the decision to bet on this type of operation only came after much debate among the specialists, who got together in a committee to evaluate the pros and cons of doing it in each patient.

In the three situations, the group’s conclusion was that the individuals (two men and one woman) had the conditions to undergo the procedure, which could bring more benefits than following other standard treatments, such as chemotherapy and radiotherapy. .

Incidentally, the advancement of other therapeutic resources against lung cancer has allowed autotransplantation to become a possibility in certain cases.

“The drugs currently available make it possible to significantly reduce the size of the tumor”, says Samano.

With that, right after the initial cycles of therapy, operations become an alternative to deal with these tiny cancerous masses.

“In the past, these individuals were not even considered eligible for surgery. But that has changed”, celebrates Samano.

How is autotransplantation?

Once the decision is made to go for the scalpel, the patient is submitted to a series of previous exams.

These tests have two main objectives: first, to ensure that the person meets the conditions to undergo the procedure; second, help the medical team to plan in detail all the steps of the intervention.

The procedure itself takes about eight hours. Basically, the patient is given anesthesia and laid on their side. The team, made up of Samano and 11 other professionals, makes the incision along the side of the body, at the height of the ribs and below the armpit.

After making the necessary cuts in the most superficial layers —skin, connective tissues and muscles, for example—, specialists reach the lobe of the lung that is affected by the tumor.

To make the withdrawal, specialists separate the three main structures that connect the lung with the rest of the body: a vein, an artery and a bronchus.

The organ is then placed on a second operating table. “It is possible to work much better there and delicately ‘sculpt’ the regions compromised by the tumor”, details Samano.

According to him, this process takes around two hours – the organ, in theory, could remain outside the body for up to six or eight hours.

In addition to facilitating the task of doctors, autotransplantation brings another advantage. The patient’s body continues to function normally while it is monitored by the rest of the team: the heart beats, the other lobe of the lung exchanges carbon dioxide for oxygen, and so on.

“It is also possible to perform the intervention through the thorax, but the safety margin is smaller and we need to deal with possible unforeseen bleeding”, adds the thoracic surgeon.

With the lobe of the lung “sculpted” and free of tumors, it is placed back in its original place through the same hole from which it was removed. Doctors sew up the veins, arteries and bronchi so that communication with the rest of the body is reestablished.

‘new’ lung

Santos’ autotransplantation took place in September 2020. He was admitted on a Sunday night and underwent surgery on a Monday morning.

Samano points out that, as the organ belongs to the individual, there is no risk of rejection by the body. With this, the patient does not need to take stronger medicines, which suppress the action of the immune system.

“The postoperative period is conventional, with pain control and follow-up, as there is a risk of pulmonary thrombosis or other complications”, describes Samano.

Santos himself, by the way, had a relapse and had to stay in the Intensive Care Unit (ICU) for a few days before being released.

In the other two patients, this more intensive care was not even necessary, according to the doctor.

One of them, who underwent the procedure in 2023 at Hospital São Luiz Itaim, but preferred not to be identified by the report, returned to professional commitments and practiced physical activity two weeks after undergoing the autotransplant.

“At the moment, none of the three individuals have any evidence that the tumor has returned,” informs Samano.

For the surgeon, these experiences reveal how, thanks to advances in medicine, cancer treatment is increasingly personalized.

“We have to see the patient as a unique individual, who needs to be evaluated in order to receive the best specific treatment for his case”, he believes.

Almost three years after the autotransplantation, Santos continues to undergo medical follow-up every three months and takes a daily pill to ensure good breathing.

Asked by BBC News Brasil how he feels after this period —and what it was like to undergo a procedure that is practically unprecedented in the country—, he answered without batting an eye.

“If I didn’t do the surgery, I would die. If I did and it went wrong, I would die anyway. So I accepted the procedure in a good way”, he says.

“And thank God I’m still alive to tell the story,” he adds.

This text was originally published here.