Meet Liam

In 2018, Liam was diagnosed with Wilm’s Tumor, a childhood cancer which affects the kidney. Ordinarily, the treatment for Wilm’s Tumor is to remove the affected organ. However, as Liam also has a genetic disease called Beckwith Wiedemann his protocol was slightly different. Helio Pedro, M.D., Section Chief, Center for Genetic and Genomic Medicine at Hackensack Meridian Hackensack University Medical Center explained that children with Beckwith Wiedemann syndrome have a higher probability of cancers in their kidney and liver during childhood. Therefore the team conducted a partial nephrectomy to remove just the infected area. Following surgery, Liam also underwent chemotherapy.

In March of 2019, after nearly a year of treatment, Liam and his family heard the words they had been waiting for. He was completed therapy and was in remission. Unfortunately, in January 2020, during his routine scan a new tumor was discovered. “While I knew this was always a possibility, I broke down,” recalled his mother Kimi. “It was devastating.”

Telling Liam he had cancer again was very difficult. “He took it well. We were all scared, but he understood,” said Kimi. “Liam is an amazing boy. He is very mature for his age. He has a terrific spirit and never complains.”

This time, however, the tumor was in his opposite kidney and the location of the tumor was not ideal for a partial nephrectomy. Katharine Offer, M.D., a pediatric oncologist at Hackensack Meridian Health Children’s Cancer Institute and a specialist in solid tumors, like Liam’s, explained, “This new tumor was smaller, but in a much more difficult position. At first, we tried to treat it with just chemotherapy. However, when that was not successful, we needed to look for a surgical solution.”

Dr. Offer consulted with Keith Kuenzler, M.D., Chief of Pediatric Surgery and Harry Koo, M.D., Pediatric Urologist, to assess Liam’s condition. “Dr. Kuenzler and I agreed that the tumor was in a very challenging position and not accessible through classic techniques. It was very important that we looked for ways to save the kidney because of Liam’s genetic condition,” said Dr. Koo.

Dr. Koo then asked Michael Stifelman, M.D., Chair of Urology and Director of Robotic Surgery at Hackensack Meridian Hackensack University Medical Center, to join Liam’s case. While robotic surgery has not typically been performed on pediatric oncology cases, Dr. Stifelman was confident that with a collaborative approach they could perform the surgery and successfully save Liam’s kidney.

Using an innovative 3D imaging tool called Iris, Dr. Stifelman was able to get a clear visualization of the tumor and its placement. “The tumor was in the middle of the kidney, buried among many arteries and veins. Removing it would be like taking a marble out of play dough.”

Dr. Stifelman felt that the robotic approach would have several advantages. First, it afforded him much better dexterity then when performing the surgery open. “The visualization is astonishing,” he commented. Second, the addition of the imaging allowed for a detailed “map” of the tumor’s location during surgery. And finally, it is a much less invasive procedure.

Liam agreed, commenting that the recovery from his second surgery was “much easier and I had very little incisions.”

In June, Dr. Stifelman moved forward with Liam’s surgery. Dr. Koo and Dr. Kuenzler also participated. Dr. Stifelman was happy to report that the surgery was successful, and Liam’s kidney was saved. He feels that Liam’s case is indicative of the approach to healthcare at Hackensack Meridian Health. “We don’t work in silos and we are constantly looking for every patient to receive all available resources to ensure the best outcome.”

Kimi and her family were overjoyed with the news. “We were so pleased they could save Liam’s kidney. We knew the surgery would be difficult, and we are very thankful to all three surgeons.”

Now that the team has successfully performed a pediatric robotic surgery, they will have the confidence to explore this technique in the future. “This is translational research occurring in real time. Using the Iris 3D Imaging and robotic expertise with a successful outcome is not being offered in most pediatric cancer centers. We are hopeful that we can use this approach for future pediatric cancer patients,” said Dr. Stifelman.

Liam continues to undergo chemotherapy for his cancer, having recently begun his last round. Dr. Offer has an optimistic prognosis for Liam. “The chemotherapy will hopefully prevent a relapse or any future growth.”

Tackle Kids Cancer supports research to identify new therapies and treatments for solid tumors and other cancers. Demonstrating the maturity his mother mentioned, Liam recognizes the importance of this mission. “Funding cancer research is very important to find a cure so all kids can enjoy events and just have fun.”

Dr. Stifelman felt that the robotic approach would have several advantages. First, it afforded him much better dexterity then when performing the surgery open. “The visualization is astonishing,” he commented. Second, the addition of the imaging allowed for a detailed “map” of the tumor’s location during surgery. And finally, it is a much less invasive procedure.

To watch a video explanation of the procedure, click here.