"There are only three rules to life: Eat when you can, sleep when you can, and don't fuck with the pancreas."

Her doctors smiled with pride. The surgery lasted 15 hours and was one of the first to involve taking so many organs out of the body: the stomach, liver, pancreas, spleen, small intestine and two-thirds of the large intestine.

Dr. Tomoaki Kato, a transplant specialist who led the team of at least nine doctors, said he hoped the procedure would be duplicated for other cancer patients and those with aneurysms or other problems associated with the abdominal aorta.

It remains unclear how often it would be needed; tumors like Ms. Zepp’s are rare, and in most abdominal surgeries, organs can be lifted or held aside.

But in the case of Ms. Zepp, 63, there was no other way to reach the tumor. After she received a diagnosis in May, doctors discovered that the cancerous tissue was entwined with several blood vessels and buried deep within.

“It wasn’t so big, but it was in a very strategic location,” said Dr. Andreas Tzakis, director of the hospital’s Transplant Institute and a member of the operation team.

Dr. Tzakis said doctors essentially had to empty Ms. Zepp’s abdomen. Then they cut out the tumor and its attached blood vessels in a matter of minutes.
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