Special therapeutic procedures
Liver surgery is the chosen procedure for patients who suffer from primary or metastatic tumors located at this organ. It offers an excellent palliation and even total recovery from the disease. The main surgical risk when resecting a part of the liver is haemorrhage. The important progress made on surgical techniques and the new technology in the last few years have permitted the use of this technique with greater radicality and a remarkable reduction of risks for the patient. The mortality rates in liver resection is quite low (2%) even in cirrhotic livers (2%-5%) or when performing extended liver surgery.
Tumor resection with conventional methods is not possible in the small number of patients whose tumor affects the inferior vena cava and the three suprahepatic veins. In these unusual (or few) cases, surgical procedures normally used in transplantation (such as hypothermic protection) are integrated in liver surgery. Therefore it is possible to resect the tumor and the vascular lesions, as well as to reconstruct the liver venous drainage. This method called "extracorporeal liver surgery” can be performed inside or outside the abdominal cavity, but always cooling the liver in order to ensure its preservation during the tumoral excision.
Less than 50 cases have been described in the world. It is recommended for patients affected by non-spread liver tumors in which conventional resection is not possible due to vascular involvement and liver transplant is contraindicated.
This complex procedure is the only therapeutic option for patients with malignant tumoral diseases (otherwise unresectable) which, regardless of their size, cause serious vascular involvement of the liver venous drainage due to their location.
Liver tumor (intrahepatic cholangiocarcinoma) with infiltration of the inferior vena cava, right liver vein, involvement of the left liver vein in the origin of the inferior vena cava.
Extracorporeal liver surgery. Right hepatectomy extended to sector IV with retrohepatic cavectomy and left liver vein implant in ring prosthesis.