Cancer Returns

Three years ago, Dr. Visit had undergone a liver transplant to treat a type of primary liver cancer called hepatocellular carcinoma. Hepatocellular carcinoma is not common in the United States but occurs much more frequently in the countries of Southeast Asia. In three years’ time, stray cancer cells from Dr. Visit’s original liver tumor had migrated to the juncture of his esophagus and stomach. He began having trouble swallowing. A rise in the alpha-fetoprotein level in Dr. Visit’s blood -- a common tumor marker for liver cancer -- led his Thai physicians to order a PET/CT scan.

The test confirmed that the cancer had returned, this time in Dr. Visit’s esophagus. The tumor was in a difficult position, attached to major blood vessels and the spine. Because of the location of the tumor and Dr. Visit’s previous abdominal surgeries, his doctors in Thailand recommended an open surgery through a large incision connecting his left chest and abdomen. They did not advocate a minimally invasive approach to remove the tumor for fear of complications.

“Since I was unhappy with their recommendations, one of my doctors advised me to contact Dr. Yieng, who is known to perform this type of complex surgery using minimally invasive technology,” recalls Dr. Visit. “Once I learned about his work, I contacted him via e-mail. We met and I had a consultation with him when he was in Thailand to deliver a lecture. I knew he was the right physician for me. Without this surgery, I did not have a chance for a cure.”

A Demanding Surgery

Within two weeks of their first e-mail communication, Dr. Visit arrived at The Valley Hospital. He underwent more testing, including an endoscopic ultrasound by Dr. Yieng. This test helped Dr. Yieng plan the surgery and accurately remove the lemon-sized tumor from Dr. Visit’s esophagus through several keyhole incisions placed in his abdomen. The surgery took six hours to complete due to dense scar tissue and the location of the tumor. Dr. Yieng had to carefully approach the surgical area and tumor to avoid injury to Dr. Visit’s transplanted liver. “This was perhaps one of my most difficult surgeries,” admits Dr. Yieng.

Dr. Visit credits Dr. Yieng’s expertise with the robot and his superb surgical skills in giving him hope for a cure.

“I hardly experienced any pain from the incision compared to the other eight surgeries I have had in the past,” says Dr. Visit. “I am grateful to everyone at Valley for making my stay so comfortable.” 

Dr. Visit was discharged from Valley after 14 days. Within one week, he was sightseeing around New Jersey and New York with his wife, Sirirat. He is slowly regaining his ability to eat semi-solid foods.

“With follow-up care from his physicians in Thailand, Dr. Visit should do well in the future,” says Dr. Yieng.