B.C. doctor reconstructs patient’s bladder from bowel following ultra-rare cancer

Trent Murdoch was preparing to celebrate some milestone family birthdays in October 2023 when he received a devastating phone call from his doctor.

“I just took down the two key highlights of what he told me,” he said.

“You’ve been diagnosed with a very rare form of cancer called signet ring cell carcinoma.”

Murdoch said survival rates from the cancer were low and he leaned on his military training to compartmentalize, move forward and prepare for the surgery.

“The process of the surgery was different than any of my other surgeries, but the care of the nursing staff, the anaesthesiologists and the medical staff supporting Dr. (Michael) Metcalf on that given day that morning was exceptional,” Murdoch said.

“And so there wasn’t any stress on my part. I go in relaxed. The best I can do is just provide them my usual sense of humour and let’s get at it.”

Dr. Michael Metcalfe, MD FRCSC, urologic oncology, who performed the surgery, said Murdoch’s case was very rare.

“Only 300 published cases have been documented in the history of literature,” he said.

“Any time you get a rare procedure, it takes a lot of discussion back and forth amongst different subspecialties in order of how to best proceed. In (Murdoch’s) case, we had a multidisciplinary conference with medical oncology, pathology, radiation oncology and radiologists, and we all put our heads together. And that being after that meeting we each individually reached out to other resources and other and other experts in the field, and it was largely felt that it was not going to benefit much from chemotherapy. And so we proceeded straight ahead with surgical resection.”

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Metcalfe said the procedure was fairly standard in his field as removing the bladder and making a new one is not uncommon.

“You take small bowel, you take out 60 cm (of) small bowel, and you essentially fold it up kind of like a baseball. And you put that where the bladder was and you have a little section connecting to the ureters and the rest of your tract.”

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Metcalfe said only about 30 per cent of bladder cancers require the removal of the bladder and many patients are not strong enough to survive the surgery.

While the surgery went well, Murdoch said at one point a stent connected to his ureter came off and he started declining. He then had to undergo more surgeries due to the leak.

While Murdoch’s test results show no sign of disease, he said he knows he’s on a timeline.

“The goal is to exceed that timeline,” he said. “I have two amazing daughters and a lovely wife — daughters that are in their early adulthood, so mentoring and transitioning them into their next stage of life is a key motivator for myself and my wife.”

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Metcalfe said robotic surgical machines, purchased by the Victoria Hospital Foundation, made a difference in Murdoch’s surgery success and recovery.

One of the machines, the Da Vinci surgical robot, is robot-assisted, meaning a surgeon is still in control of it, Metcalfe explained.

“The goal is for this to be involved in major urological surgeries, whether it be prostate cancer or for bladder cancer, for removal of the bladder like what (Murdoch) had, or for removal of smaller kidney tumours and removing just a part of the kidney tumour and sparing the rest of the kidney.”

Metcalfe said he and Murdoch have now become friends.

“Through his 40 different procedures and seven different operations and six months essentially in the hospital, a bond forms and there are certainly some very personal moments between us,” he said.

“As things were looking grim, especially for (Murdoch’s) outcome, where you didn’t know what the outcome would be and you just had to rely kind of on each other to get through it. And thankfully we did.”

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