In some cases, a laparoscopic or hand-assisted surgery can be used to perform a liver resection, or a removal of part of the liver. The surgeons will review your case and decide whether it may be possible, safe, and effective to perform your surgery in this way. It allows for smaller incisions and a more rapid recovery. We are now able to offer this type of surgery in approximately 50% of liver resection cases.
Some patients require more complex surgical planning and a combination of treatment techniques to help them on the road to liver surgery. Prior to undergoing removal of their liver cancer, another treatment modality may be used to help shrink the tumor or prepare the liver for surgery.
For example, up-front chemotherapy (called “neoadjuvant”) may be performed to prime the cancer for removal or decrease the size and number of tumors that have to be taken out with surgery.
If there are too many tumors to be safely removed with surgery alone, we frequently use a combined approach with radiation oncology and stereotactic body radiation therapy (SBRT). Liver SBRT is a rapidly emerging non-invasive technique that allows for precise delivery of high doses of radiation to the tumors. In the same patient, we can use surgery to remove some liver tumors and SBRT to treat the others. This allows us to offer aggressive surgical resection to patients with multiple tumors or tumors in an unfavorable location for removal.
In other cases, a technique called portal vein embolization (PVE) is used to grow the healthy side of the liver before surgery. This allows even patients with larger tumors to be considered as surgical candidates. A type of doctor called an Interventional Radiologist uses a catheter through the skin to limit the blood flow to the cancerous side of the liver. The side with the cancer then shrinks (atrophies) over 3-4 weeks, while the healthy side grows (hypertrophies). Surgery is then performed to remove the cancerous side and leave behind a safe amount of liver tissue for the body to function.
Thanks to this teamwork between specialties --and our aggressive technical approach-- surgery is now an option for an increasing number of patients with cancer in the liver and bile ducts.
To find out whether you or a loved one may be eligible for these services, contact our office at (412) 359-6738.