Re-aligned small intestine becomes substitute for lost esophagus
After many years as a smoker, Gilbert Hudson knew he had an increased risk for developing lung cancer. That made the discovery of cancer in his esophagus a real surprise, but what followed his diagnosis for that cancer drastically altered his life.
Hudson had endured radiation and chemotherapy elsewhere before doctors used a piece of his large intestine to replace his esophagus, lost to surgery designed to remove as much of the cancer as possible. He had been willing to go through with that procedure because without that transplant, he would have to continue to rely upon a feeding tube implanted in his abdomen to replace the lack of esophagus—and that feeding tube was not a good fit for him. "The formula I had wasn't agreeing with me. I was losing a pound a day," he said.
He did his best to accept the situation, but his desire not to have others see him struggle with the tube meant he and his wife stopped visiting with friends. And there was no point in going out to eat. He fell ill with pneumonia; dehydration followed, and then, complications with the large intestine transplant that put him in the hospital for nearly a month. At diagnosis, he'd weighed 204. Now he was down to 150. He could not even swallow his own spit. "I was just ready to call it quits," Hudson said.
Microsurgery enables new options
Gilbert's wife, Kathy, however, was not ready to give up. When her husband's first set of surgeons said they weren't willing to do another procedure on him—and suggested he try Stanford, she was ready to make the drive from their home in central California. "We'd heard of Stanford, and we'd heard good things, but you don’t know until you put the shoes on how comfortable they fit," Kathy Hudson said. "We felt welcomed right away."
Hudson was now in the hands of a collaborative Stanford team with a long track record of successful esophageal transplant using an unlikely approach, the small intestine, over more common procedures including gastric pull-up and the large intestine.
Stanford's team combined the expertise of a cancer surgeon, Jeffrey Norton, chief of surgical oncology; Joseph Shrager, chief of thoracic surgery; and Gordon Lee, director of microsurgery in the division of plastic and reconstructive surgery. "Total esophageal reconstruction is a difficult procedure," said Lee. It requires a match of size, blood supply and tissue quality that will support the passage of food and avoid the leakage and tissue death that can mark other choices of transplanted tissue.
"Stanford has made a practice of using the small intestine," Lee said.The small intestine's diameter is a close match to that of the esophagus and its mucosal and lubricated tissue works well as a conduit. Stanford's approach also incorporates a painstaking microsurgical connection of blood vessels to build an ongoing blood supply for the transplanted intestine. "It's not an easy operation," Lee said, "and we do it as a team."
Transplant results proven
Norton was the first of his Stanford doctors Hudson met "and he told me once he had me hooked up, I could live pretty much a normal life. He said he'd done quite a few of these and they were all successes. That relieved me quite a bit," Hudson said.
Lee saw someone, like others who had faced esophageal cancer, whose lives had been disastrously changed because they could not eat or drink. Instead of having "to tell patients I'm sorry, there's nothing else that can be done, we have this approach," Lee said.
Lee told Kathy Hudson that he would be exclusively on call for her husband to monitor his condition after the surgery. "You know how wonderful that made me feel?" she said. Within hours, Hudson was sitting up in a chair and his recovery has since been steady. "I'd never heard of this kind of transplant, but I hope they do it for other patients so they won’t have to go through what I did."
Hudson admits that he sometimes eats more in one sitting than he should—and that he doesn't always stick to the non-spicy diet recommended for him. "Nobody knows what it feels like not to eat for months and months and then actually have food in your mouth," he said. "It tastes so good."