Jonathan Cope lay sedated on an operating table as Matthew Hanasono, M.D., removed his cancerous lower jawbone. Meanwhile, another doctor extracted the fibula bone from Cope’s lower leg.
Using surgical tools resembling those of a sculptor, Hanasono painstakingly whittled away at the fibula, fashioning it into a new jawbone for his patient.
When he was done, he placed the new jaw where Cope’s cancer-riddled jaw had been, adjusting it till it “fit like a puzzle piece.” The arduous surgery lasted eight hours and challenged Hanasono’s skills not only as a doctor, but also an artist.
“Contouring straight leg bone into curved jaw bone is extremely challenging,” says Hanasono, a professor of Plastic Surgery. “If the fit isn’t precise, patients can become disfigured and have trouble chewing, swallowing or talking.”
He and other experts have long realized the need for a way to increase surgical precision and efficiency. Luckily, three-dimensional printing has emerged as a solution.
Eliminating the guesswork
MD Anderson is one of a growing number of cancer centers embracing 3-D printer technology to create exact replicas of body parts damaged by cancer. These replicas, or models, serve as templates to guide doctors like Hanasono as they carve and shape customized, implantable body parts out of patients’ own bones or tissues. The fibula is used to form jawbones for patients such as Cope because it’s a non-weight-bearing bone and, therefore, not essential to walking.
“Designing and making replacement body parts out of bone or cartilage once involved a lot of trial and error,” Hanasono says. “Getting accurate measurements and a good fit wasn’t easy, but 3-D printing eliminates the guesswork. Models are printed in three dimensions — length, width and height — and are precise replicas of the patient’s original jaw or other body part that needs replacing.”
Hanasono uses these models not only to create replacement body parts, but also to plan exactly how a surgery will go.
“I can take precise measurements of the model from different angles before surgery. That helps me strategize my every move,” he explains.
This surgical planning cuts down on time spent in the operating room and leads to better outcomes for patients.
When Allison Easley awoke one morning with soreness under her right armpit, she thought she’d pulled a muscle. But the pain soon became worse, and her lymph nodes started to swell.
“I wondered if I’d caught an infection from one of the kids,” says Easley, 29, a special events photographer who days earlier had taken class portraits at an elementary school.
Antibiotics prescribed by her family doctor didn’t help, and when her pain became unbearable, Easley, who lives just north of San Antonio, visited her local emergency room. Doctors there did a lymph node biopsy and found melanoma, the deadliest form of skin cancer. It wasn’t Easley’s first encounter with the disease.
Ten years earlier, at age 19, she’d been diagnosed with melanoma when a suspicious-looking mole alerted doctors to the disease. They surgically removed it, allowing Easley to live cancer-free for almost a decade.
But now, the melanoma was back with a vengeance.
Imaging scans revealed thirty tumors scattered throughout her body. Within months, six would spread to her brain.
“The possibility I’d relapse was always at the back of my mind,” Easley says. “When you’ve had cancer, you’re always waiting for the other shoe to drop.”
Her cancer had been spreading swiftly and silently, and was now stage 4 — the most advanced form of the disease.
This time, Easley sought care at MD Anderson, where doctors prescribed chemotherapy, radiation and powerful new immunotherapy drugs that rallied her immune system and helped her body fight hard.
The drugs eliminated all Easley’s tumors — except those in her brain.
“A protective network of blood vessels known as the blood-brain barrier prevents foreign substances from crossing into the brain, but it also can prevent life-saving drugs from entering,” says Ganesh Rao, M.D., associate professor of Neurosurgery at MD Anderson’s Brain and Spine Center.
Brain surgery to remove Easley’s tumors seemed like her only remaining option, but there was a problem. A particularly large tumor had embedded itself deep in the center of her brain, between the right and left hemispheres. Any attempt to reach it surgically would most certainly damage areas that control motor skills affecting coordination and movement.
“This is the juncture where many doctors tell patients their condition is inoperable,” says Rao. “But at MD Anderson, we have another way to reach unreachable tumors.”
“I wasn’t allowed to eat for two days prior to surgery, I had to do a bowel preparation, and I was incredibly weak when I was wheeled into the operating room.
After surgery, I was in bed for quite some time,” Jenkins recalls. “When I finally could walk around, it was really painful. After going home, I distinctly remember my husband cooking — the smell of spices made me cough, and the coughing caused such incredible pain that I had to tell him to stop.”
A decade later, when Jenkins’ cancer returned and her MD Anderson doctors determined that surgery was again necessary, she jumped at the chance to participate in a protocol designed to relieve patients’ symptom burden and improve functional recovery.
To her absolute surprise, Jenkins’ experience with her second operation was dramatically different than her first.
“The night before, I enjoyed a family dinner, drank clear liquids until two hours prior to surgery, and didn’t have to endure a bowel preparation that had caused so much discomfort,” she says. “After surgery, I had almost no pain — I was up and walking and was soon eating a full meal. I even felt well enough to talk to my friends and put on my makeup in recovery.”
The principles of MD Anderson’s Enhanced Surgical Recovery Program (ESRP) involve making interventions before, during and after surgery that get patients through their surgery and recovery process much quicker and with better outcomes.
The movement is not new. Rather, it was pioneered almost two decades ago by a group of surgeons in Europe. It’s only more recently that physicians and institutions in the United States, including MD Anderson, have started to look more closely at its components.
Actually, many surgical practices are based more on traditions and previous teachings than sound scientific evidence, explains Pedro Ramirez, M.D., professor of Gynecologic Oncology and Reproductive Medicine.
“The pioneers of the movement questioned many traditional standards of practice that had been ingrained in the care of patients before, during and after surgery, and by doing so, came up with strategies that could benefit the patient,” says Ramirez, an ESRP co-lead. “With implementation, they found that patients were recovering much faster and getting back to their regular activities much sooner, resulting in an obvious improvement in quality of life.”
A gynecology ESRP has already registered 597 patients since its initiation in November 2014. Since then, there’s been a one-day drop in average length of hospital stay, an 80% reduction in opioid consumption and an improvement in patient-reported outcomes, without noting any differences in postoperative complication rates or readmissions. The program also has significantly lowered the cost of caring for patients.
When triathlete Maria Lea De Jesus was diagnosed with early stage cervical cancer in 2014 after a routine Pap test, she feared being sidelined from her sport.
“I run -- a lot. I just can’t sit still,” says Lea, 49. She trains for endurance sports six days a week, year-round. Her accomplishments include completing over 10 marathons and two IRONMAN triathlons – a 2.4-mile swim, followed by a 112-mile bike ride and a 26.2-mile run...