Advanced Liver-Sparing Surgery for Primary and Metastatic Liver Cancer

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• Liver-Preserving Surgery Goal
• Vascular Clamping Risks
• Water-Jet Dissection Technique
• Benefits of Gentle Dissection
• Preventing Liver Failure
• Full Transcript

Liver-Preserving Surgery Goal

Liver resection is a critical treatment for both primary liver cancer and metastatic tumors, such as those from colorectal cancer. Dr. Christoph Maurer, MD, emphasizes that a primary goal of this complex surgery is to preserve as much healthy liver tissue as possible. This liver-sparing philosophy is central to achieving the best possible outcomes for patients. The approach prioritizes maintaining organ function while completely removing all cancerous lesions.

Vascular Clamping Risks

A common technique to control bleeding during liver surgery is vascular clamping. Dr. Anton Titov, MD, discusses how this procedure stops blood flow into and out of the liver. However, Dr. Christoph Maurer, MD, explains that this ischemia, or lack of blood flow, causes significant damage to the liver. The organ's function suffers during the operation and continues to be impaired postoperatively. This hypoxic damage to the healthy liver remnant can lead to serious complications and a slower recovery for the patient.

Water-Jet Dissection Technique

Dr. Christoph Maurer, MD, utilizes a meticulous surgical alternative to clamping: gentle water-jet dissection. This advanced technique uses a pressurized stream of water to carefully separate liver tissue. The water-jet dissector damages the liver parenchyma in a controlled way, which clearly exposes the blood vessels and bile ducts. This enhanced visibility allows the surgeon to precisely ligate or clip these structures without rushing and with minimal blood loss. The procedure is highly reliable, though it may take slightly longer to perform than other methods.

Benefits of Gentle Dissection

The benefits of this no-clamp, water-jet technique are substantial for patient recovery. Dr. Christoph Maurer, MD, highlights that the avoidance of liver tissue ischemia is a key advantage. The remaining healthy liver is left undamaged, which translates to fewer postoperative complications. Patients are stronger during their recovery period and can often be discharged from the hospital more quickly. This not only improves the patient's quality of life but also reduces the overall costs associated with the liver cancer surgery and hospital stay.

Preventing Liver Failure

This surgical approach is particularly crucial when a patient has a critical liver remnant. Dr. Anton Titov, MD, and Dr. Christoph Maurer, MD, discuss scenarios where only 30% to 35% of the original liver volume remains after tumor resection. Preserving the function of this small remnant is a matter of life and death. Liver failure is a severe and potentially fatal complication of surgery. By using a gentle dissection method that avoids vascular clamping, surgeons significantly reduce the risk of postoperative liver insufficiency and protect the patient from this grave danger.

Full Transcript

Resection of the liver to treat primary or metastatic liver tumors is important. What are the best liver cancer treatment options? Preserving as much healthy liver as possible is one goal of treatment.

Dr. Anton Titov, MD: Let's continue talking about liver resection. Liver cancer surgery is common for metastatic tumor resections, such as colon cancer metastases. Liver cancer surgery also removes primary liver tumors, such as hepatocellular carcinoma. But the main risk of surgical operations on the liver is bleeding.

Most surgeons actually stop the blood flow into and out of the liver. This is called vascular clamping. But if you prevent the blood flow to any organ, including the liver, the organ function suffers. Clamping of blood vessels prevents blood flow, and liver function continues to suffer after the surgery.

You have developed a particular surgery technique of liver cancer resection without vascular clamping. What is your liver cancer surgical technique? How does it benefit patients with primary or metastatic liver cancer?

Dr. Christoph Maurer, MD: Perhaps it's a little bit exaggerated that we developed this liver cancer technique. But what we use is a very careful liver dissection technique. We use a gentle water-jet dissection of liver tissue to carefully remove the tumor.

Water-jet is a dissection technique where the liver parenchyma gets damaged, but it makes you clearly see the blood vessels and the bile ducts in each liver segment. Therefore, you can ligate blood vessels and bile ducts, or you can clip them without stress and without bleeding.

This gives the liver cancer surgeon very good control during the surgical operation. It is a procedure that takes a little bit longer to perform. Other liver dissection techniques are faster, but they require stopping blood flow to the liver.

This liver cancer surgery technique is very reliable. You can see the liver structures very well and do an occlusion of these structures in a very reliable manner. This is perhaps also the reason why in split-liver procedures most liver surgeons use the water-jet dissector.

Because the water-jet dissector shows you the vascular structures of the liver very nicely, you can perform your liver cancer surgery procedures without any risks. After the surgical operation on the liver, you have a small blood loss and you have avoided liver tissue ischemia.

That means you have no hypoxic damage to the healthy remaining liver. This is important for postoperative recovery after liver cancer surgery. You have fewer complications, patients are stronger during recovery, and patients go home quicker. So, at the end, you also save costs of liver cancer surgery.

Dr. Anton Titov, MD: So that's important. This careful liver dissection technique without stopping blood flow improves liver function after surgery. It also improves the quality of life of the patient after the operation. Liver cancer surgery method without stopping blood flow to the liver improves liver function. Liver functions better during and after the operation.

Dr. Christoph Maurer, MD: Absolutely. For me, one of the most important things is this: often after surgery you have a critical liver remnant of 30% or 35% of total liver volume before surgery. Then you are very glad to have left this healthy liver remnant without any damage.

So you risk less liver insufficiency and less liver failure. Liver failure after cancer surgery always has a potential for death of the patient.

Dr. Anton Titov, MD: That's very important for all the patients with liver cancer to understand before choosing their liver cancer surgeon.

Dr. Christoph Maurer, MD: Correct.