Novel liver surgery allows Georgia teen to graduate high school tumor-free

Credit: Allison Adams

Credit: Allison Adams

Kelsey’s issues began five years ago. A swollen stomach and abdominal pain sent her to the emergency room at Memorial Health in Savannah when she was 13. Doctors removed a tumor attached to her pancreas and part of her colon and spleen in a complicated surgery with a recovery that included several setbacks, including a clot in her lung and its near collapse.

She said she was fine for four years, and then leakage from her belly button in April 2024 led her to Children’s. Testing revealed new tumors, which meant the previous cancer had returned and spread to her liver.

Around that time, Children’s was planning to rebuild its pediatric liver transplant program, said Dr. Bhargava Mullapudi, Children’s surgical director of abdominal transplant. The health system also had recently begun using a treatment that involved injecting tiny, radioactive beads of a substance called Yttrium-90 (Y-90) into the blood vessels supplying the tumors. Few pediatric centers in the country offer this treatment.

Before the new transplant team could try to remove the tumors, the medical team needed to stop the growth of the existing tumors and prevent additional ones from growing elsewhere. The oncology team administered three rounds of chemotherapy, and the interventional radiology team administered the customized, targeted dose of Y-90 radiation to kill the tumors.

Then, Mullapudi performed the tumor removal surgery with Dr. Richard Hendrickson, both of them among the few physicians in the country dually trained in pediatric surgery and transplant surgery. They removed the tumors, leaving about 20% of the liver, just enough to avoid immediate liver failure and allow Kelsey to live a healthy life without restrictions. A liver transplant, part of a backup plan if the surgery wasn’t successful, would have compromised Kelsey’s immune system and exposed her to a lifetime of potential infections, along with other challenges, Mullapudi said.

Her body also may have rejected the transplant, he added.

In the past, the combination of procedures Children’s used to treat Kelsey were only available to adults with liver cancer, mostly as a bridge to a transplant, Mullapudi said. Without much medical guidance for how to treat Kelsey’s rare tumor clusters, the specialists at Children’s creatively devised a care plan that considered whether she would need a transplant if so much of her liver were removed. Doctors try to avoid transplants, when possible, he said.

“We were confident in our surgical expertise and how we could support the remaining liver, so we were able to do it.”

Credit: Children's Healthcare of Atlanta

Credit: Children's Healthcare of Atlanta

Post-operative care included pain control and maintaining normal bodily functions so the remaining liver could recover, Mullapudi said.

Cancer researcher Max Langham believes Children’s medical approach — using several specialty teams to find the best treatment plan for a particular child — is at the forefront of modern cancer care.

“This is a great example of how multidisciplinary teams ought to work together to solve a difficult problem,” said Langham, a retired pediatric surgeon, emeritus surgery professor at the University of Tennessee Health Science Center and a member of the surgery committee of Children’s Oncology Group.

To ensure Kelsey’s health, doctors at Children’s Healthcare of Atlanta will continue to monitor Kelsey’s tumor cells through general checkups and scans every six months for two to five years.

“If there’s no recurrence in the remaining portion of the liver, she should be able to live a normal life. She will not have to take any precautions as she would have, especially in the first couple of years after a transplant.”

Signs of complications could include abdominal pain, weight or appetite loss or general fatigue, he said.

Kelsey said she’s relieved she didn’t need a transplant. “I was so scared of it, to get used to it afterward, the medicine I’d have to be on to regulate everything, that my body could reject it at any point in time.”

She’s also thankful she hasn’t had any complications so far compared to the first surgery she had in Savannah.

Her mother, Allison, echoes her daughter’s gratitude for the doctors who ensured her successful treatment. “They were willing to try something new for us.” She also recalled the camaraderie of parents with sick children, some of whom died during treatment. “There were happy moments and sad moments. We may not even speak the same language, but we cried with each other.”

Kelsey admits the treatments interfered with her senior year of high school, and she had to rush at the end of the academic year to complete her assignments to graduate on time. “Right before the surgery, I had six papers due.”

But she realizes she was luckier than others treated at Children’s. “You think you have it bad, and then someone else has it worse than you,” she said. “It’s mind-blowing to me that something so rare can happen to anyone.”

The experience also solidified her decision to pursue nursing. Already a certified nursing assistant, she plans to attend Southeastern Technical College in Vidalia next year to become a registered nurse. She has been taking prerequisites, dual-enrolled there and homeschooled through Abeka Academy, which is based in Florida.

In the future, she wants to offer advice, tips and tricks to patients who may be scared or angry. “Honestly, just to be a shoulder for them to lean on if they need it.”

As a patient, she was able to study the nurses who monitored her care. “To hear about them and their stories really meant a lot. Honestly, it opened my eyes. It also taught me to appreciate how short and special life is.”

Kelsey hopes her case serves as a model for other treatments at Children’s and elsewhere. “If I can help someone else, even just one person, that would be just amazing to me.”