Increasing the Survival of Liver Cancer Patients

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International Physician Update

SURGERY

Increasing Survival for Liver Cancer Patients


Surgeon Michael Choti uses intraoperative ultrasound and new devices that allow him to go through the liver relatively bloodlessly.

By using ultrasound more aggressively to draw a map to tumors in the liver, and new surgical tools to reach and resect them, Hopkins surgeons are finding that some tumors once considered inoperable are inoperable no more. And as a result, they’re prolonging the life of liver cancer patients.

“Our outcomes are getting better and better,” says surgeon Michael Choti of patients who have undergone surgery to remove tumors spread from colon cancer. “Historically, 30 percent of patients were alive five years after surgery, but our most recent experience shows over 50 percent of patients still alive after five years” (Annals of Surgery, June 2002).

Choti explains that the results are due in part to advances in CT, MRI and PET imaging that help to more accurately determine which patients are the best candidates for surgery. Then, with those patients during their operation, Choti does something not all surgeons do—he runs an ultrasound probe over the exposed liver to plan a pathway to the tumors that will minimize damage to healthy liver tissue. He likens this approach to a gardener being able to see branches, or blood vessels, to prune. Next, using new surgical dividing and stapling tools that allow him to cauterize blood vessels and tissues before cutting through them, he is able to get to the tumor with little blood loss to this very vascular organ.

“Aggressive use of intraoperative ultrasound and these new special devices allows us to go through the liver relatively bloodlessly,” Choti says. “We can map out our lines, lower blood loss, operate both more aggressively and more safely, and achieve better outcomes.”

Combining chemotherapy or chemoembolization with surgery more often, as well as doing more repeat operations, Choti adds, contribute to prolonged survival, too. For many patients who are not candidates for surgery because of significant cancer spread or poor general health, Choti relies on radiofrequency ablation therapy to destroy lesions with heat. In either an open operation or a minimally invasive laparoscopic approach through a small incision in the abdomen, Choti inserts a thin, electrical probe into each lesion. An electrical current then passes through the electrodes, heating them to a temperature of approximately 100 C, resulting in a slow but deadly burn.

In a 1999 Italian study of patients with small primary liver cancer, RF ablation destroyed 93 percent of the lesions without complications or return of the tumors. In another European study of 29 patients with larger tumors, 66 percent of liver tumors were eliminated with no complications or recurrence.