August 30, 2009 - 0 comments
The patient Mr. R. Jain, a 58-year-old male from Jodhpur, Rajasthan was diagnosed with a cancerous tumor in his liver (Hepatocellular Carcinoma- HCC) in October 2006. What followed the diagnosis was a liver resection involving removal of a part of the liver containing the tumor.
Almost two-and-a-half years later, a follow-up ultrasound and a CAT scan of the liver revealed the presence of three new tumors, one of which was extending dangerously behind the IVC – inferior venacava, the big vein
in the abdomen that runs behind the liver, carrying blood from the lower half of the body to the heart.
Intricacies involved in this risky surgery
Owing to the dangerous location of the tumor, doctors whom the patient was consulting advised against a second surgery, and had put him on palliative treatment in the form of TACE (Transarterial chemoembolisation) - a procedure in which the blood supply to a tumor is blocked and chemotherapy is administered directly into the tumor.
While two of the three nodules could be treated with TACE, the nodule close to the IVC could not be embolised (blocked), thereby causing him untold mental distress and helplessness. That’s when the patient decided to consult doctors at the Wockhardt Hospitals’ Department of Hepato Biliary- Pancreatic Diseases and Liver Transplantation.
“Since the tumor was limited only to the liver and had not spread anywhere else in the body, we took an informed decision to perform a Right Hepatectomy and remove the tumor behind the IVC,” recalls Dr. Surendra Kumar Mathur, senior consultant surgeon, HPB Surgery & Liver Transplantation, Wockhardt Hospitals, who successfully headed the 11-hour surgery.
“It was, no doubt, a technically challenging surgery since liver as such is densely adhered to other organs in the vicinity like the diaphragm, colon and the duodenum, and more crucially, a first surgery had already been done on the patient’s liver. The patient who required three units of blood was shifted from the ICU two days post operation, and was immediately started on oral medication. Patient recovery was uneventful and he was discharged on the sixth day post surgery,” adds Dr. Mathur.
To the patient’s biggest relief, the histopathology report revealed that hepatocellular carcinoma with active disease in the nodule adjacent to the IVC, had been excised entirely. The previously recommended TACE treatment would have let the cancer grow within, foretelling a grave future for the patient.
Liver tumors and complexities of re-resection surgery
Major or complex resections of the liver are performed mainly for malignant tumors of the liver which can be either primary, i.e. arising from the liver like hepatocellular carcinoma (HCC), or metastasis, i.e. they originate in some other organ and then seed the liver.
World over, though the recurrence of HCC liver tumor after first surgery is reported to be around 30 percent over five years, only one third of these cases are known to be retreated successfully. Commonly, many surgeons choose to avoid an excision surgery of a liver tumor very close to the IVC due to a possible life-threatening bleeding of the IVC during the surgery.
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