Montréal enSanté V8N3 Été/Summer 2016 | Page 67

g Quelques mois plus tard , une biopsie révélait la mauvaise nouvelle . Serges a appris qu ’ il avait un cholangiocarcinome hilaire . Cette forme rare de cancer est généralement difficile à traiter parce que les tumeurs se développent là où les canaux biliaires hépatiques gauche et droit se rejoignent , et souvent elles ne peuvent être enlevées chirurgicalement . Serges a été vu immédiatement par le Dr George Zogopoulos , un chirurgien du CUSM spécialisé en chirurgie hépato-pancréato-biliaire et en transplantation , et chercheur au sein du Programme de recherche sur le cancer de l ’ Institut de recherche du CUSM ( IR-CUSM ). Ce fut le début d ’ un long périple .
Un cas nécessitant une expertise de haut niveau « Nous ne pouvions pas opérer Serges , parce que le cancer était situé au milieu des voies biliaires et que sa maladie du foie compliquait la situation , explique le Dr Zogopoulos . J ’ avais un intérêt de recherche pour ce protocole unique en son genre et je savais que nous avions l ’ expertise au CUSM et à l ’ Institut de recherche pour le réaliser , même s ’ il n ’ avait jamais encore été complété avec succès ici . Lorsque Serges a choisi de rester à Montréal , nous avons chapeauté le protocole , puis mis sur pied une équipe multidisciplinaire et admis Serges à l ’ hôpital pour qu ’ il puisse y recevoir le traitement . »
Serges a dû passer une batterie de tests pour pouvoir participer au protocole . « Ils ont effectué des examens sur mon cœur , mes os , ma vésicule biliaire , mes yeux et ma peau , se rappelle Serges . L ’ équipe clinique a fait preuve d ’ un grand professionnalisme et de compassion . Je n ’ ai jamais senti que j ’ étais le premier patient à m ’ engager dans ce protocole de recherche au CUSM . »
Sur une période de trois mois , plus de 20 professionnels incluant des infirmières , des chirurgiens en transplantation , des oncologues et des radiologues ont travaillé jour et nuit auprès de Serges . Le protocole , qui combine la radiothérapie , la chimiothérapie et une greffe du foie , exigeait de franchir de nouvelles étapes quasi quotidiennement . g gg Even if it was still at an experimental stage , Serges decided to go through with it at the MUHC to stay close to his wife and family . “ I also had confidence in the clinical team at the Royal Victoria Hospital ( RVH-MUHC ),” he says . Serges was first diagnosed with primary sclerosing cholangitis ( PSC ), a disease in which the bile ducts – small tubes through which the digestive liquid bile flows from the liver to the small intestine – progressively decrease in size due to inflammation and scarring . At that time he was told by his gastroenterologist he would need a liver transplant in the future , but since no date was confirmed , he went on with his life .
A few months later , a biopsy was the bearer of bad news . Serges learned he had hilar cholangiocarninoma . This rare form of cancer is often difficult to treat because tumours develop where the right and left hepatic bile ducts come together , and often , they cannot be surgically removed . Serges was immediately seen by Dr . George Zogopoulos , an MUHC surgeon who specializes in hepato-pancreato-biliary and transplant surgery and who is a researcher in the Cancer Program of the Research Institute of the MUHC ( RI-MUHC ). It was the beginning of a long journey .
A case requiring high-level expertise “ We could not operate on Serges because the cancer was located right in the middle of the bile ducts and his liver disease made it more complicated ,’’ explains Dr . Zogopoulos .” I had research interest in this special protocol and I knew we had the expertise at the MUHC and the Research Institute to do it , even if it had never been successfully completed in the past here . So , when Serges decided to stay in Montreal , we championed it , put together a multidisciplinary team and got Serges admitted to the hospital to follow the treatment .’’
Serges had to pass a battery of tests to be able to take part in the protocol . “ They performed exams on my heart , my bones , my gall-bladder , my eyes and skin ,” he recalls . “ The clinical team was very professional and compassionate . They never made me feel like I was ‘ the first patient ’ to undergo this research protocol at the MUHC .”
Over a period of three months , more than 20 people including nurses , transplant surgeons , oncologists and radiologists worked day and night with Serges . The protocol , which combined radiation therapy along with chemotherapy and a liver transplant , required different steps almost every single day .
Dr . Zogopoulos collaborated with MUHC gastro-hepatologist Dr . Peter Ghali , who had completed a fellowship in Hepatology and Liver Transplantation at the Mayo Clinic . On top of working with MUHC experts in their respective fields such as Dr . Jamil Asselah , medical oncologist , Dr . David Valenti , radiologist , and Dr . Neil Kopek , radio-oncologist , they were in regular contact with research leaders abroad to get guidance on Serges ’ unique case .
“ The key to success is not just having the expertise but allowing experts to interact frequently ; it is the communication that makes all the difference ,” says Dr . Peter Ghali , who is also a researcher from the Experimental Therapeutics and Metabolism Program of the RI-MUHC . Medical updates on Serges ’ condition had to be done daily and at a very high level of expertise . You need the hospital to be able to put these specialized services under one roof , which is exactly what we have right now at the Glen . And that is why it worked .”
Against all odds After successfully completing the radiation and chemotherapy treatments , doctors had to make sure Serges ’ cancer had not spread . Once confirmed , he finally received his liver transplant . Unfortunately , he developed a severe postoperative infection , and his hospital stay was extended . gg
SUMMER 2016 MONTRÉAL enSANTÉ 65
g  Quelques mois plus tard, une biop- gg  Even if it was still at an experimental stage, Serges decided to go through with sie révélait la mauvaise nouvelle. Serges a it at the MUHC to stay close to his wife and family. “I also had confidence in the clinical hilaire. Cette forme rare de cancer est gé- with primary sclerosing cholangitis (PSC), a disease in which the bile ducts – small tubes appris qu’il avait un cholangiocarcinome néralement difficile à traiter parce que les team at the Royal Victoria Hospital (RVH-MUHC),” he says. Serges was first diagnosed through which the digestive liquid bile flows from the liver to the small intestine – pro- tumeurs se développent là où les canaux gressively decrease in size due to inflammation and scarring. At that time he was told by joignent, et souvent elles ne peuvent être was confirmed, he went on with his life. biliaires hépatiques gauche et droit se reenlevées chirurgicalement. Serges a été vu his gastroenterologist he would need a liver transplant in the future, but since no date A few months later, a biopsy was the bearer of bad news. Serges learned he had hilar immédiatement par le Dr George Zogopou- cholangiocarninoma. This rare form of cancer is often difficult to treat because tumours chirurgie hépato-pancréato-biliaire et en be surgically removed. Serges was immediately seen by Dr. George Zogopoulos, an MUHC los, un chirurgien du CUSM spécialisé en transplantation, et chercheur au sein du Programme de recherche sur le cancer de l’Insti- tut de recherche du CUSM (IR-CUSM). Ce fut le début d’un long périple. Un cas nécessitant une expertise de haut niveau « Nous ne pouvions pas opérer Serges, parce que le cancer était situé au milieu des voies biliaires et que sa maladie du foie compliquait la situation,  explique le Dr  Zogopou- los. J’avais un intérêt de recherche pour ce develop where the right and left hepatic bile ducts come together, and often, they cannot surgeon who specializes in hepato-pancreato-biliary and transplant surgery and who is a researcher in the Cancer Program of the Research Institute of the MUHC (RI-MUHC). It was the beginning of a long journey. A case requiring high-level expertise “We could not operate on Serges because the cancer was located right in the middle of the bile ducts and his liver disease made it more complicated,’’ explains Dr. Zogopoulos.”I had research interest in this special protocol and I knew we had the expertise at the MUHC and the Research Institute to do it, even if it had never been successfully completed in the past here. So, when Serges decided to stay in Montreal, we championed it, put together a multidisciplinary team and got Serges admitted to the hospital to follow the treatment.’’ Serges had to pass a battery of tests to be able to take part in the protocol. “They per- protocole unique en son genre et je savais formed exams on my heart, my bones, my gall-bladder, my eyes and skin,” he recalls. “The l’Institut de recherche pour le réaliser, même was ‘the first patient�