Jim Kelly's latest cancer surgery was a complicated and long procedure that will require more work to eventually complete the job.
But the former Buffalo Bills quarterback is doing well enough following the key operation – a 12-hour affair performed March 28 at Mount Sinai West in New York City – that he will likely leave shortly to return home, the lead surgeon in the case said Friday in a video released by the hospital.
"I'm very optimistic," said Dr. Mark L. Urken, a head and neck surgeon. "The interesting thing about cancer of the palate, unlike cancers of other parts of the anatomy of the oral cavity, is that it is a very forgiving structure."
Urken said he expects Kelly to recover with excellent function, including his ability to speak.
He will be able to eat solid food again once he is outfitted with implanted teeth in another procedure.
Kelly, 58, was diagnosed with squamous cell carcinoma in 2013, and doctors removed part of the upper jaw, part of the roof of his mouth and numerous teeth. Kelly's cancer came back in 2014, having spread to his maxillary sinus cavity and adjacent tissues. After radiation and chemotherapy, he announced later that year that he was once again cancer-free.
This time, there was either a recurrence of the old cancer or a new tumor in his right upper jaw. It led to what Urken described as a "really difficult operation."
The surgical team first made a CT scan of Kelly's head. The doctors used the images to produce a 3D model of his anatomy to help plan the operation and the reconstructive work he would need.
In addition to removing the tumor, surgeons wanted to take out bone on the other side of the upper jaw, where Kelly had previously received radiation. The radiation had damaged the tissue, and doctors were concerned that it would be a source of pain for Kelly if it was not removed.
"Everything is a little more challenging when a patient has been previously irradiated. It slows the healing process. It leads to more swelling," Urken said.
At the end of this sequence of the operation, the surgical team took what's known as a frozen section, to analyze tissue to confirm that all the tumor had been removed.
Next, physicians began the reconstruction.
They took bone from Kelly's fibula – the smaller of the two bones in the lower leg. The other bone, the tibia, is the weight-bearing bone. They also took an artery and vein, as well as skin from the calf.
The fibular bone is shaped to match as closely as possible the sections of jaw that are removed. The skin is used to reline the oral cavity. Meanwhile, the vein and artery are transferred to make sure blood can circulate to the transplanted bone and skin.
Otherwise, the donor tissue would not survive in its new location.
All of this is a long and complex process that, with the help of computer modeling, can be done in less time and with greater accuracy.
"It used to be done freehand and didn’t always work out the way we wanted it to. It is now much more accurate, and the results are incredible," Urken said.
One complication occurred when the surgeons realized that the donor vein and artery from the calf were not long enough for their new location in Kelly's face.
They had to perform vein grafts, with veins taken from Kelly's leg, to bridge the gaps. Blood circulation in the reconstructed area is critical to success, Urken said.
Once Kelly recuperates over the next few months, he will require more surgical work.
This includes what Urken described as a minor procedure to contour the soft tissue in his palate. Doctors also will place dental implants in the new, reconstructed bone so that he can be fitted with a prosthesis that functions like normal teeth.
Kelly, in recent days, began to take all his nutrition by mouth, a major milestone for a patient and a sign that he is ready to leave the hospital.
"He has come through all of this remarkably well," said Urken, who described Kelly as "incredibly courageous."