Doctors at Bai Jerbai Wadia Children’s Hospital in Parel have performed ex situ liver surgery with auto-transplantation on a two-year-old girl diagnosed with advanced liver cancer, which the hospital says is the first of its kind in India.
The girl, Aphsa, was diagnosed with locally advanced hepatoblastoma after her mother noticed abdominal swelling. Initial chemotherapy caused partial tumor shrinkage, but the cancer continued to block major blood vessels, making standard surgical removal unsafe.
“Despite shrinkage with chemotherapy, the tumor still completely obstructed blood outflow from the liver, requiring complete removal of the liver and extensive vascular reconstructions, something not possible through standard surgical methods,” said Dr. Abhishek Mathur, head of the hospital’s Division of Liver Transplantation and Hepatobiliary Surgery.
Liver transplantation was considered the preferred treatment option, but no living or deceased donor organs were available during the critical period after chemotherapy. Doctors then opted for an ex situ surgical approach.
In ex situ liver surgery, the organ is temporarily removed from the body, operated on externally to remove tissue affected by cancer, and then returned to the patient. This approach allows surgeons to reconstruct major blood vessels and ensure complete removal of the tumor, which may not be possible with conventional surgery.
During the 14-hour procedure performed on December 12, 2025, Aphsa’s entire liver, weighing about 500 grams, was removed and preserved outside the body for 4.5 hours using an oxygenated hypothermic machine perfusion system.
Surgeons removed approximately 70 to 80 percent of the cancer-affected tissue and reconstructed the remaining healthy segment of the liver before autotransplanting it back into the child.
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“This rare ex situ surgical technique involves removal of the entire liver, followed by cooling and preserving the organ outside the body. This approach provides access to remove the liver affected by the tumor and perform meticulous reconstruction of the blood vessels,” said Dr. Mathur.
Two teams of surgeons worked simultaneously during the operation. “While one team removed the tumor and reconstructed the healthy liver in the hypothermic machine, the other team performed a complex reconstruction of the major blood vessels inside the child’s body,” said Professor Darius Mirza, Professor of Surgery and Mentor of the Hospital’s Liver Transplant Division.