HOW TO MAKE UNOPERABLE LIVER CANCER OPERABLE??

In the previous posts of my blog I have mentioned that surgery is the only curative treatment for liver cancer either primary liver cancer or cancer spread to liver.

And all liver cancers are surgically curable if 20% of healthy liver can be spared.

Now the question arises what if by pre operative investigation we find that 20% of healthy liver is not possible to save. Is there a way out????

Answer is thankfully yes.

Research has proved that we can use potential of liver to grow after surgery in pre operative settings also.

Insulin rich blood from gastrointestinal system before going to other part of the body first reach the liver, studies have shown this insulin content of the blood that is reaching liver is the primarily responsible for the growth of liver.

Now if by some way we are able to divert these insulin rich blood from the part that we want to remove to the part that we do not want to remove than this part can grow and can achieve size more than 20% and thus can make surgically incurable liver cancer to surgically curable liver cancer.

There are three ways to achieve it.

1.    Portal vein ligation:

Surgically in the first stage we can ligate that part of blood vessel, which takes blood to the liver. And re assess liver volume after 3-4 week. This method has not gained very much popularity because need of two surgeries and also increase in liver volume is not that satisfactory.

2.     Portal vein embolization:

This is an interventional radiological method by which branch of the vessels supplying the liver can be blocked percutaneously (via small injection on skin). This is the most widely used method where as this procedure can be done non surgically.

Main drawback of this method is it takes 3-6 weeks to achieve desired enlargement of the liver. SO there is always a risk that cancer can spread during this time period.

portal vein embolization   

                 _{ALPPS Procedure vein is ligated and liver is cut but not removed}

3.     Associated portal vein ligation with in situ liver splitting (ALPPS):

This novel method to increase size of liver were discovered recently in 2011 only in which though it requires surgery but liver size is shown to increase to desired level in just 7-14 days. In this method portal vein is tied as in portal vein ligation method but liver is partially cut along with it but not removed. It is shown that this cutting is responsible for rapid increase in size and tumor can be removed by doing second surgery just in 7-14 days. There are encouraging reports of this method and this can be the future of liver surgery.

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 So take home message for today’s discussion is there are many ways and means to cure cancer spread to the liver. You should never loose hope. Fight the disease,take advise of trained liver surgeon and we can bear the disease.