Leading expert in gastrointestinal cancer surgery, Dr. Martin Schilling, MD, explains the critical link between liver preservation and cancer recurrence. He details how growth factors released to regenerate the liver after surgery can also stimulate the growth of any remaining cancer cells. His liver-sparing surgical approach minimizes healthy tissue removal. This strategy significantly reduces the risk of metastatic tumor regrowth. Starting chemotherapy soon after surgery is also a key component of effective treatment.
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Liver-Sparing Surgery for Cancer: Preventing Metastatic Recurrence
Jump To Section
- Liver Regeneration and Cancer Link
- Key Surgical Principles
- Importance of Chemotherapy Timing
- Liver Segment Resection Technique
- Clinical Practice Statistics
- Role of Medical Second Opinion
- Full Transcript
Liver Regeneration and Cancer Link
The liver is a unique organ with a powerful ability to regenerate after resection. Dr. Martin Schilling, MD, explains that this process is driven by specific growth factors circulating in the patient's blood. These same growth factors have a dangerous dual effect. They not only stimulate the regeneration of healthy liver tissue but can also stimulate the growth of any remaining cancer cells, both in the liver and elsewhere in the body as metastases.
Key Surgical Principles to Prevent Recurrence
To counteract the risk of growth factor-stimulated cancer recurrence, Dr. Schilling outlines two critical principles. The first is to preserve as much healthy liver tissue as possible during cancer resection surgery. This approach is vital for both primary liver cancer and metastatic liver cancer operations. The second principle is to initiate chemotherapy treatment very quickly after the surgical procedure to target any microscopic cancer cells before they can proliferate.
The Critical Importance of Chemotherapy Timing
Starting chemotherapy soon after liver cancer surgery is a non-negotiable part of the treatment protocol. Dr. Martin Schilling, MD, emphasizes that this rapid post-operative intervention is essential to neutralize the effect of the circulating growth factors. By administering chemotherapy quickly, oncologists can prevent these factors from fueling the regrowth of metastatic deposits, thereby improving long-term outcomes for patients.
Liver Segment Resection Technique
The practical application of the liver-sparing principle involves a specific surgical technique. Instead of removing large portions of the liver, surgeons perform parenchymal-sparing operations. This means resecting only the individual liver segments that contain the cancerous tumor. Dr. Schilling advocates for this precise method to maximize the amount of healthy liver tissue left behind, which in turn minimizes the secretion of pro-cancer growth factors.
Clinical Practice Statistics and Outcomes
Dr. Martin Schilling, MD, applies this liver-sparing technique in approximately 90% of his liver cancer patients. This results in a dramatically low hemihepatectomy rate of only 15%. A hemihepatectomy involves removing 50% or more of the liver. Dr. Martin Schilling, MD, notes that this contrasts sharply with many other centers, where hemihepatectomy rates can be around 50%, indicating a significant difference in adherence to this crucial oncological principle.
The Role of a Medical Second Opinion
For patients diagnosed with advanced cancers like stage 4 gastric cancer with liver metastases, seeking a medical second opinion is highly valuable. As discussed by Dr. Anton Titov, MD, a second opinion can confirm the diagnosis and help determine if liver metastases surgery is a viable and optimal option. Consulting with a leading expert ensures patients receive the best treatment plan, which may include advanced liver-sparing surgical techniques not widely available elsewhere.
Full Transcript
Dr. Anton Titov, MD: Let's discuss liver cancer, both primary or metastatic cancer. You have studied liver regeneration after liver cancer surgery. Please share your experience about treating primary liver cancer or metastatic liver cancer.
Dr. Martin Schilling, MD: The liver is a very unique organ. It can regenerate after you resect it. Regeneration of the liver is done by a number of growth factors that circulate in the cancer patient's blood.
Dr. Anton Titov, MD: Those growth factors stimulate not only the growth of the liver. These growth factors can also stimulate the growth of remaining tumor cells in the liver. There are also metastatic cancer cells in the rest of the body.
Dr. Martin Schilling, MD: Physicians have to prevent cancer cells from being stimulated by liver growth factors. Growth factors are secreted after the liver cancer resection surgery.
Therefore, you have to do two things. First, you have to always preserve as much liver as possible during liver cancer surgery. It is true both for primary liver cancer and for metastatic liver cancer.
Second, you have to start treating the liver cancer patients with chemotherapy very fast after liver cancer surgery. That's what we do in our treatment of primary liver cancer or metastatic liver cancer.
The surgical aspects of this problem can be solved in this way. We do liver parenchymal tissue sparing operations. The cancer surgeon must resect the single liver segments. Remove only liver segments that contain the cancerous tumor.
In my clinical practice, we would do that procedure in about 90% of all liver cancer patients. Therefore, our rate of hemihepatectomy is only 15%. Hemihepatectomy is removing 50% of the liver or more.
Usually, other liver cancer surgery centers have a rate of hemihepatectomy of about 50%. Many other centers ignore this very important oncological principle.
Dr. Anton Titov, MD: That is a very significant difference.
Dr. Martin Schilling, MD: Yes, it is.