Upstate News

August 21, 2006
Doretta Royer 315 464-4833

University Hospital now performs liver resections to treat liver cancer

SYRACUSE, N.Y. – University Hospital is the only hospital located between Albany and Rochester to offer liver resection to treat liver cancer. The surgery is available through the Hepatobiliary Program, a joint program of the hospital’s Departments of Surgery, Radiology and Oncology and the Division of Gastroenterology in the Department of Medicine.

Liver resection is the surgical removal of a portion of the liver that has one or more cancerous tumors, and of its surrounding tissue. Chemotherapy, radiofrequency ablation or radiation therapy prior to and or following liver resection may be necessary for patients in some instances. The treatment is most appropriate for patients who have primary liver cancer or cancer that has metastized to the liver.

According to Dilip Kittur, M.D., recent advances in surgical and interventional radiology techniques, as well as in imaging techniques, have made liver resection a viable option to treat liver cancer. “Liver resection dates back to the 1700s,” said Kittur, founder and director of the Hepatobiliary Surgery Program, chief of general surgery and director of transplantation at University Hospital. “However it was not determined to be a truly effective option to treat liver cancer until the development of recent innovations in techniques.”

Kittur uses a number of procedures to improve the safety of the surgery, including the ultrasonic dissector, called a Harmonic Scalpel, that cuts across the liver’s functioning cells without injuring vessels and bile ducts and that coagulates smaller blood vessels which leads to less bleeding.

To determine a patient’s suitability for the surgery preoperatively, Kittur uses three-dimensional CT scans or magnetic resonance imaging (MRI) to view how much of the liver can be removed safely, the extent of cancer and whether there is enough of the non-tumor portion of the liver, free of cirrhosis, to sustain the patient’s life.

“The liver has the remarkable capacity to reproduce itself in just a matter of weeks,” said Kittur, who gained considerable experience in liver surgery, including resection and transplantation, as a faculty member at Johns Hopkins University prior to joining SUNY Upstate and most recently through continuing medical education at Memorial Sloan-Kettering Cancer Center.

“A cirrhotic liver can reproduce itself but it continues to do so with the cirrhosis, resulting in limited functional liver tissue,” he said. “In cirrhotic patients with primary liver cancer, it may be possible to perform a segmental resection and still preserve sufficient liver function for survival.”

To perform a liver resection, Kittur uses a number of surgical techniques, including the removal of sections and/or lobes of the liver as needed; a wedge resection (the removal of any portion of the liver less than an anatomic lobe); or a left lateral segmentectomy that involves the removal of the liver’s right or left lobe.

However, there are risks associated with liver resection, as with any treatment option for liver cancer. “The liver is the largest organ in the body, surrounded by major blood vessels,” he said. “The important technical challenge of liver resection is hemostasis or the arrest of bleeding in the surrounding blood vessels.”

Kittur says that despite the challenges, liver resection is clearly an established operation in the surgical armamentarium. “However the technical demands of these procedures and the potential metabolic consequences indicate that they should not be undertaken lightly,” he said.

As with any major surgical undertaking, postoperative complications can occur following a liver resection, including fever, persistent bile drainage, loss of blood from a stress ulcer, hemorrhage, wound infection or liver failure.

The hospital stay for liver resection ranges from two to three weeks. Most insurance companies cover costs associated with the operation. Patients may be referred to the Hepatobiliary Program for the procedure by their primary care physician or by their gastroenterologist.

University Hospital’s Hepatobiliary Program offers comprehensive treatments for patients with liver cancer or benign liver tumors. Other procedures performed by the program in combination with resection include radiofrequency ablation and chemoembolization.

According to MedicineNet.com, the five-year survival rate of liver resection is about 30 to 40 percent in patients whose tumors are successfully resected. Many of these patients however may have a recurrence of cancer elsewhere in the liver.

The liver is the largest gland/organ of the body, lying beneath the diaphragm. It secretes bile and is also of great importance in both carbohydrate and protein metabolism. It is the only organ/gland in the body that can regenerate, or reproduce itself.

Kittur, who performs the liver resections at University Hospital, has written more than 70 papers and book chapters, including Technique of Liver Resection in Shackleford’s Textbook of Alimentary Surgery.

For more information about liver resection at University Hospital, call the Hepatobiliary Program at 315-464-8668.

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