Special therapeutic procedures
Surgery is the privileged option when treating primary or secondary tumors located in the liver or in the biliary system, and is normally chosen as the therapeutic procedure in these cases. During their expading growth, these tumors can affect surrounding organs or adjacent structures.
This effect has been considered an unquestionable reason for surgical inoperability or unresectability for a very long time. The great technical difficulty and the scarce benefit offered to patients conditioned these often dismissed criteria. However, that decision meant ruling out the possibility of palliation with long survival periods –and, in some cases, recovery–. The important technical and technological progress, that is now used by surgical teams with long experience in the field have permitted changing this criteria gradually.
Due to the anatomical location of the liver, the gallbladder and the biliary tree, the most frequent diagnosis are involvement the diaphragm and abdominal wall, right adrenal gland, surrounding organs (duodenum, hepatic flexure of the colon or pancreas) and inferior vena cava. On the other hand, the attempt to obtain an adequate surgical resection with free margins obliges in many occasions to extend the resections to vascular structures (main portal or lobar vein and hepatic artery) or close biliary structures. This kind of resections imply a great surgical challenge, but the following anatomic reconstructions (mainly vascular ones) demand a special technical learning aside from the specific one for liver and biliar surgery.
The ample experience of our Deparment during the last few years shows that 10% of the patients with tumors located at the liver or at the biliary tree needed an extended resection for the other structures. In all cases, a complete resection of the tumor has been possible without increasing the surgical morbimortality. Moreover, we have encountered a remarkable increase of survival in similar tumoral processes (non-spread tumors with an aggresive local component).
As long as the characteristics of the tumor require, following chemoradiotherapy completes the therapeutic treatment.
Right liver resection extended to segment IV.
Double portal resection, main portal vein and left portal vein in origin, without the need of venous graft.
Liver metastasis from colorectal carcinoma with infiltration of inferior vena cava and diaphragm.
Right liver resection extended to segment IV and inferior cava vena.