The Challenge

Last Tuesday, the first incision was made at about 10 a.m. It was tough going from the start. Scar tissue from the radiation treatment had essentially welded Mr. Collison’s insides together, requiring hours and hours of delicate dissection just to free organs and tissues so that surgeons could work on them. In addition, the bulging tumor had shoved organs and blood vessels out of its way, distorting Mr. Collison’s anatomy. The right side of his liver was squashed flat. Nothing was where it was supposed to be. Dr. Kato and his team had to rummage through their patient’s belly in search of veins they could normally have found with their eyes closed.

As the operation wore on through a day and a night, and then another day, exhausted nurses and surgeons rotated in and out. Dr. Kato, calm and soft-spoken, rarely left the room. Much of the time, Evelina Badalov, his physician’s assistant, worked by his side. Dr. Kato’s focus, patience and stamina did not ebb.

“He’s like a machine,” one of the surgeons said. “He loves this.”

The surgery was really a series of dauntingly complex operations. A certain amount of ground had to be ceded to the tumor, because it had a stranglehold on parts of Mr. Collison’s stomach, intestines and pancreas. Each of those organs had to be cut in two, so the healthy parts would stay with Mr. Collison while the entangled parts, including two-thirds of the stomach, would be taken out with the tumor. The portions that stayed had to be reconnected to the digestive tract.

Several blood vessels had also been captured by the tumor and would have to be replaced. Dr. Kato had to rebuild parts of two major veins with Gore-Tex tubes and replace another with the internal jugular vein from Mr. Collison’s own neck.

And because major blood vessels would have to be clamped off before the liver could be removed, Dr. Kato would also have to reroute Mr. Collison’s circulation temporarily through a pumping machine.

The Operation: Day 1

Surgery is a stunning blend of finesse and brute force. The incision was a huge, cross-shaped cut that ran from Mr. Collison’s breastbone to his pubic bone, then across his belly near the navel. Metal retractors needed to hold open the wound looked like tools from a hardware store, and it took three people to wrestle them into place. Electrocautery pens that did much of the cutting sparked, smoked and sent up a stench of burning flesh. Suction probes like bigger versions of the ones that dentists use gurgled as they vacuumed blood from the incisions.