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Resecting the unresectable: The right place, the right team
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In April 2023, CV Rao had just returned from a work trip in Europe when he started experiencing abdominal pain on his right side. His wife, a doctor, recognized that he needed to see his primary care physician for an ultrasound scan.
When the ultrasound didn't show anything, CV's care team ordered a CT scan. The results were alarming — a 7 centimeter tumor, the size of a large peach, was in his liver.
"It was a shock to the system," CV recalls.
The initial diagnosis suggested intrahepatic cholangiocarcinoma, a rare and aggressive cancer of the bile ducts.
CV quickly received a PET scan, an MRI and a biopsy at a local hospital which confirmed those suspicions. Within eight days, CV was undergoing chemotherapy to shrink the tumor so he might be eligible for surgery.
After six cycles of chemotherapy, the tumor was reevaluated. The good news was that the cancer was responsive to chemotherapy, and the tumor had shrunk by about 50%. Unfortunately, because the tumor surrounded major blood vessels, local surgeons still deemed it inoperable.
Seeking a second opinion
Determined to explore all options, CV sought a second opinion at Mayo Clinic.
"I was working on 3D printing investments and kept running into Mayo's innovative approaches," he explains. "Everywhere I looked, they had this 3D printing effort where the surgeons were able to visualize what they were operating on using 3D printed organs."
This led him to believe that Mayo Clinic could offer a solution.
A new hope
Six months after diagnosis, CV and his wife, Madhavi, sat across from Harmeet Malhi, M.B.B.S., a hepatologist at Mayo Clinic in Rochester.
"We want to give every patient every chance. Undergoing surgery was his best chance at being tumor-free."
Harmeet Malhi, M.B.B.S.
After reviewing his imaging and personalized treatment plan with Dr. Malhi, CV and his wife met with Patrick Starlinger, M.D., Ph.D., a hepatobiliary and pancreas surgeon.
"Dr. Starlinger looked at me and said, 'You came to the right place. We can help you with this,'" CV remembers.
All three liver veins appeared to be involved. This type of tumor usually is not removable because there must be at least one vein to drain the liver, according to Dr. Starlinger.
"We told him to continue chemotherapy to maximize his response, aiming to get the tumor even smaller. And then we planned for advanced, complex liver surgery."
Patrick Starlinger, M.D.
Although CV understood this would be a high-risk procedure, he remembers feeling reassured after speaking with Dr. Starlinger.
"Dr. Starlinger looked at his fellows and said, 'Would you say this is routine?' And they all said 'Yes, it's a routine surgery for us,'" CV says.
As a native of Austria, Dr. Starlinger explains, "In German, we have a word that means saying 'yes' to life, 'lebensbejahend,' and that's how CV approached this. Both CV and his wife had such positive attitudes and a willingness to fight this with all they had."
CV believes the same can be said of Dr. Starlinger's approach to his case.
"The very first day, Dr. Starlinger walked in with a positive attitude, which is one of the things that you realize you absolutely need to get through things like this," CV says.
Resecting the unresectable
CV's surgery was scheduled for November 22, 2023, the day before Thanksgiving.
To prepare for the operation, Dr. Starlinger turned to a 3D printed model of CV's anatomy, just like the ones that had led CV to Mayo Clinic.
"3D models are incredibly helpful in complex surgical procedures because they allow for optimized surgical planning prior to the actual surgery," Dr. Starlinger explains.
At 6 a.m. on Nov. 22, CV was taken back to the operating room for the complex, 4.5-hour surgery.
"We carefully dissected through the liver until we approached the right hepatic vein, which was really the critical portion of CV's operation," Dr. Starlinger says. "We had everything prepared to reimplant the only remaining liver vein, but with meticulous precision, using an ultrasound dissection device, we were ultimately able to peel the tumor off the majority of the right hepatic vein and perform a primary repair of the vessel."
Dr. Starlinger and the surgical team removed roughly 50% of CV's liver, along with the entire tumor. The surgery was a success.
Experiencing cherished milestones
Nearly two years after his diagnosis, CV is returning to the activities he loved. He has resumed skiing, attended his younger son's robotics competitions, and even traveled to Switzerland and Austria with his wife.
"I can't wait to see my older son graduate and drop him off at college," he shares with a smile. "We are in a stage of life where a lot of life events are happening. It's amazing to do these things that are important to the family."
These moments, once clouded by uncertainty, are now cherished milestones.
Reflecting on his care at Mayo Clinic, CV expresses deep gratitude to the team that provided him with expert and compassionate treatment.
"The Mayo Clinic staff is beyond what we've experienced elsewhere," he says. "During my seven days in the hospital, we interacted with many nurses, and through changes in shifts, it was just a uniformly amazing experience. Every, every single person we came in touch with was such a positive experience."
"We wish Dr. Starlinger the longest career possible because the number of lives he has and will save is incredible," he says.
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