The path to a groundbreaking surgery

Fall 2012

A patient's perspective on his life-saving decision

If a doctor told you about a procedure they learned about while attending a medical conference, would you agree to be the first patient they try it out on? What if it was the only option that had the potential to save your life?

This is exactly the decision that Richard Brunet faced last November.

When Richard Brunet met with surgeon Dr. Roberto Hernandez-Alejandro at London Health Sciences Centre, he had already been treated by multiple doctors, undergone surgery to remove a tumour from his colon and was in the midst of chemotherapy treatments. It had only been four short months since he was first diagnosed with cancer, which had started in his colon and spread to his liver.

This meeting was the next step in his battle to beat cancer. It was here that he would be presented with a unique surgical option, which had been developed in Germany for advanced cancer in the liver, and would have the potential to rid the cancer from his body and add years to his life. There was just one caveat – Dr. Hernandez-Alejandro had never performed the surgery before. In fact, no surgeon in Canada had.

It was a procedure that Dr. Hernandez-Alejandro had heard about while attending an international medical conference: a complex two-staged surgical removal of cancer from the liver. The first surgery would remove the tumour on the left side of Brunet’s liver and cut off the blood supply to the right side, where four additional tumours were lurking. In the time between the two surgeries, the right side of his liver would shrink from the lack of blood flow and the left side would grow exponentially from the new excess blood flow. The second surgery, which would take place just one week after the first, would remove the right side of Brunet’s liver and therefore, all of the remaining cancer.

While Dr. Hernandez-Alejandro felt that Brunet was an ideal candidate for what would be a Canadian first, with little more than a first impression of Dr. Hernandez-Alejandro, Brunet wasn’t quite as certain.

“This was my first meeting with Dr. Hernandez and for me personally, making such a huge decision without having the luxury of time to build a relationship with a certain level of trust would be difficult,” says Brunet. “I was in a high-risk, high-reward situation where each procedure had to work in order to move on to the next – in order for me to have a chance at living. With those odds, I needed something more before I would be ready to hand over my life.”

Brunet, a self-described take-charge type of person, would employ a straightforward approach to get the “more” that he needed. He would look Dr. Hernandez-Alejandro straight in the eyes and ask him how good he was.

“I didn't want him to tell me he was very good at what he did, as I would expect him to be good,” says Brunet. “When he told me he was very passionate about what he did, instead of how good he was, it made the deliberation process to go ahead with the surgery easier. I had always told my employees at work that every person is good at something, but you can't be great unless you are passionate about it. Dr. Hernandez absolutely used the right terminology to convince me.”

As a result of the chemotherapy treatments he was undergoing at the time, Brunet would have to wait nearly six months before it would be medically safe for him to endure the two surgeries. The first of the two took take place on May 24. It took eight hours, but it went perfectly. Seven days later, he emerged from the second surgery with a new lease on life.

“It’s been a long haul, but the system worked for me,” says Brunet. “Thanks to Dr. Hernandez, the dedicated liver anaesthesia team and the many other doctors, nurses and medical staff I saw along the way, I’m here today. I’m able to spend time with my family and am looking forward to finally enjoying my retirement.”

Dr. Hernandez-Alejandro was the first in Canada to perform this two-stage surgery, completing the first stage on April 23 and the second on May 1 of this year. While Brunet ultimately ended up being the second patient in the country to have this surgery, because of the timing around the chemotherapy he had been receiving, he will always be the first to have said yes.

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Patient Richard Brunet (left) credits the passion that Dr. Roberto Hernandez-Alejandro (right) has for his work with making the decision to proceed with a never been done in Canada surgery easier.
Graphical depiction of ALPPS procedure