Secondary Liver Cancer and Surgical Skill
Consultant Liver Surgeon, Mr Robert Hutchins from Barts & The London Hospitals says, “The key to successful liver surgery is the complete removal of all tumours leaving behind sufficient liver tissue to keep vital functions of the body operational.” However, despite the skills of the surgeon the cancer may have spread to other parts of the body, so the question is – what should be done in these circumstances, and what are the options?
What is Secondary Liver Cancer? And what are the surgical and non-surgical treatment options?
Especially in the two years following the successful treatment of a primary liver cancer unfortunately many patients will go on to develop secondarycancer in other parts of the body such as the bones, lungs and liver. Sometimes the disease will have already spread by the time that the cancer is diagnosed. The development of secondary disease does not reflect any failure on behalf of surgical treatment or subsequent chemotherapy or radiotherapy treatments.
Liver treatment is most often surgical but non-surgical treatments are constantly being developed. The survival benefit of these new treatments is not as clear as with surgical removal of the tumour but they are becoming more commonly employed and may be given in conjunction with liver surgery.
Examples of the newer technologies for treating liver secondary cancer include:
Radiofrequency Ablation - Ablation techniques offer heat or cold treatment to physically destroy tumours once needles to deliver the temperature change have been passed into the tumour
Microwave Ablation - uses heat from microwave energy to destroy cancer cells
HIFU - very high frequency ultrasound to destroy tumours from outside the body
Cyberknife - very high dose, very accurately localised radiation therapy
SIRTEX - utilises tiny beads emitting radiation that are passed into the blood supply of tumours in the liver.
All of these technologies avoid surgery, but small procedures may be needed and in some cases a general anaesthetic.
Liver Units in the UK were established to allow surgeons to gain the required specific expertise. Due to the difficult complex procedures required, the surgeon’s skill and experience is the biggest factor affecting a successful outcome. The mortality from liver surgery for bowel cancer secondaries should be less than 3%. In many UK centres it is less than 1%. The morbidity or rate of complications is about 20%. This includes mild liver failure, leak of bile from the cut surface of the liver (about 5%), infections of the wound, chest and abdominal cavity, bleeding or the general risks of anaesthesia especially on the heart and lungs.