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Michael E. DeBakey VA Medical Center - Houston, Texas

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VA Docs Help Veteran Grow A New Liver

October 26, 2010

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The Virtual Tumor Board allows VA physicians throughout the South Central United States to tap into the specific and unique expertise of a team of cancer experts at the Michael E. DeBakey VA Medical Center. Daniel Anaya, M.D., surgical oncologist and director of the DeBakey VA Liver Tumor Program (right), and Katsuhiro Kobayashi, M.D., staff interventional radiologist, meet with Veteran Robert Coote, Jr. and his grandson during a follow-up appointment. PHOTO: Public Affairs Officer.

HOUSTON – Cancer treatment experts at the Michael E. DeBakey VA Medical Center (MEDVAMC) recently combined two unique procedures to successfully treat a 58-year-old Veteran suffering from life-threatening liver cancer.

A routine test performed by his health care provider at the VA Medical Center in Jackson, Mississippi found Robert Coote, Jr. had a serious liver lesion. Doctors told him he only had six months to live, but also gave him hope by referring him to the Liver Tumor Program at the Houston VA.

"Mr. Coote was immediately examined by our multidisciplinary team of experienced and knowledgeable cancer care specialists," said Daniel A. Anaya, M.D., surgical oncologist, director of the DeBakey VA Liver Tumor Program, and an assistant professor of Surgery/Surgical Oncology at Baylor College of Medicine. "It was determined liver resection, the surgical removal of a portion of his liver, was the best treatment option. However, in order to be completely safe, he also needed to undergo a portal vein embolization."

The liver is a unique organ because it can re-grow after part of it has been removed. However, the body does require that a minimum amount of liver be left behind following surgery in order to give the body enough time for this re-growth to occur.

In some circumstances, the tumor in the liver is so large, that a large amount of liver would need to be removed so that all the disease can be taken out. In these circumstances, physicians utilize portal vein embolization to help the liver re-grow before the surgery. Patients who previously were not candidates for surgery, due to the small amount of liver that would be left behind, can now undergo surgery and have successful and safe removal of their tumor.

"During the procedure, a needle is placed through the skin into the blood vessel in liver that has the largest portion of the tumor," said Katsuhiro Kobayashi, M.D., staff interventional radiologist, who performed the portal vein embolization on the Army Veteran. "This blood vessel is then cut off, tricking the liver into making the other side grow."

"This whole thing came out of left field and I was scared" said Coote. "When I told family that I was going to the VA for treatment, they asked if I had considered other choices. But I saw how careful and thorough the VA doctors were and I knew they would take good care of me."

After six weeks, Coote’s liver was of sufficient size that surgery was deemed safe. Anaya and his team performed a right liver resection and the patient was discharged six days later.

"My care at the VA has been amazing," said Coote. "I now have very positive prognosis and look forward to taking my grandchildren fishing and seeing them grow up."

"The Liver Tumor Program at the Michael E. DeBakey VA Medical Center offers Veterans the latest medical and surgical treatments available for cancer," said David H. Berger, M.D., M.H.C.M., Operative Care Line executive and professor of Surgery at Baylor College of Medicine. "The Michael E. DeBakey VA Medical Center constantly strives to open new doors and make new medical alternatives available for our Veterans."

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Awarded the Robert W. Carey Organizational Excellence Award in 2005, the Robert W. Carey Circle of Excellence Quality Award in 2007, and re-designation for Magnet Recognition for Excellence in Nursing Services in 2008, the Michael E. DeBakey VA Medical Center serves as the primary health care provider for more than 120,000 veterans in southeast Texas. Veterans from around the country are referred to the MEDVAMC for specialized diagnostic care, radiation therapy, surgery, and medical treatment including cardiovascular surgery, gastrointestinal endoscopy, nuclear medicine, ophthalmology, and treatment of spinal cord injury and diseases. The MEDVAMC is home to a Post Traumatic Stress Disorder Clinic; a Network Polytrauma Center; an award-winning Cardiac and General Surgery Program; a Liver Transplant Center; a VA Epilepsy Center of Excellence; a VA Rehabilitation Research of Excellence focusing on mild to moderate traumatic brain injury; and one of the VA’s six Parkinson’s Disease Research, Education, and Clinical Centers. Including the outpatient clinics in Beaumont, Conroe, Lufkin, Galveston, and Texas City, MEDVAMC outpatient clinics logged almost one million outpatient visits in fiscal year 2009. For the latest news releases and information about the MEDVAMC, visit www.houston.va.gov.