Cutting the liver piece by piece

08/26/2014
Photo: Laparoscopy of the liver

Instead of cutting open the abdomen, the surgeon makes four small holes. He can then use trocars, which are stiff tubes, to insert his instruments and a camera; © Yngve Vogt/ University of Oslo

New surgical methods give hope to patients with cancer that has spread from the intestine to the liver. The disease can be changed from terminal to chronic by cutting the liver piece by piece using keyhole surgery.

“With our new surgical method we can transform an acute, terminal disease into a chronic disease,” says one of the world’s leading surgeons in the field of laparoscopy (keyhole surgery), Prof Bjørn Edwin at the Intervention Centre of UiO and Oslo University Hospital, Norway. His solution is to preserve as much of the liver as possible. The most common surgical method is still to remove half of the liver if the cancer has spread to parts of it.

“By removing only a small piece at a time, we increase the chances that the patient can have repeat surgery. In other words, we try to preserve the liver to have some of it left if the cancer should return. Most of the patients have a recurrence within ten years. The idea is this: If we leave parts of the right side, we can later remove the left side of the liver. This is what we refer to as good liver housekeeping”, Bjørn Edwin explains. He notes that the method only works for patients in whom the cancer has spread from the intestine to the liver. For patients with a primary tumor in the liver, other treatment methods are used.

“With laparoscopy, we can intervene and operate many times, since the method does not produce the same adhesions as open surgery does. The results are equally good, and there are fewer complications. In addition, laparoscopy has taught the surgeons to operate more neatly,” Bjørn Edwin states to the research magazine Apollon.

This way to perform surgery is far better for the patient than a classic operation. Instead of cutting open the abdomen, the surgeon makes four small holes. He can then use trocars, which are stiff tubes, to insert his instruments and a camera. One hole is for the video camera. Through the other holes, the surgeon can introduce a forceps, an instrument, a scalpel or other implements needed to cut the liver loose. Before starting the procedure, however, they must first inflate the abdomen to provide a large cavity where they can work.

Laparoscopy is not only less painful than classic surgery, but the patients recover more quickly and spend fewer days in hospital.
“The average hospitalization period after a laparoscopic intervention is three days, while patients spend five to seven days in hospital after open surgery.”

Edwin is currently investigating the correlation between surgical methods and survival rates.

“Based on the illness histories of patients who have been operated on for cancer that has spread to the liver, expected survival is higher with laparoscopy, but the responses are not statistically significant. We don’t know exactly why the survival rates increase, but it might be related to the immune response.”

MEDICA.de; Source: University of Oslo