When diagnosed with liver cancer, many people may be pessimistic about their recovery. Liver cancer seems to have become a verdict that haunts and undermines the patient's spirit. In fact, with the right curative measures, liver cancer can be cured and restored, as is the case with this patient.
A liver cancer patient comes with a fairly large tumor. The size of the liver in the left lobe is very small, while the large right lobe is being overgrown by cancer. According to the family, several hospitals said there was no hope of recovery for the patient. He was only advised to undergo palliative therapy because his condition was deemed impossible to undergo surgery.
After a detailed analysis, we considered that surgery could still be performed until the tumor in his liver was removed cleanly. The challenge is in determining the tumor boundaries and the path of the cut which must be determined with great precision so that more healthy liver tissue can be preserved.
The operation which lasted for several hours was successfully carried out. This elderly patient underwent a 6 day recovery period without experiencing any complications. For liver cancer fighters or their families, the story above can bring hope that recovering from cancer is not impossible.
How to handle surgery on liver cancer patients?
Liver cancer treatment can be done in two ways, namely curative and palliative. Palliative care is carried out to improve the patient's quality of life, either as a companion to curative treatment or fully palliative when the patient is declared incurable. Whereas in palliative measures, treatment can be done in two ways, namely:
- Surgery or tumor resection
Liver cancer surgery is the first choice to be performed as long as the general condition of the patient and the condition of the tumor make it possible to undergo surgery. - Transplant
This action can be the next choice when surgery or other methods are considered ineffective in curing the patient's condition. Usually a liver transplant or transplant is performed if the patient's liver function condition is not good or accompanied by moderate-severe liver cirrhosis . Liver transplants can also only be performed if the patient meets the criteria for liver transplant based on the Milan criteria, UCSF criteria , or Hangzhou criteria .
What needs to be considered regarding surgery in liver cancer patients?
Liver cancer is a tumor or lump in the liver that is malignant. Meanwhile, liver resection is the surgical removal of the tumor from the liver.
This operation is the main choice of curative treatment for liver cancer patients. In patients with early-stage liver cancer, surgical removal of the tumor gives the patient the best chance of recovery. After the tumor is removed, the liver naturally has the ability to regenerate (grow back) from the remaining healthy parts of the liver. However, this operation can only be done if the patient still has a healthy part of the liver that is considered sufficient to live. In theory, the patient should have at least 30% normal liver remaining. Especially in liver cancer patients with fatty liver or cirrhosis, there must be at least 40% or more remaining.
Some liver cancer patients may not qualify for this operation. One of the reasons is because the cancer has spread to other organs or the remaining healthy liver is judged to be insufficient. Patients who do not meet the criteria for liver resection will be evaluated by a multidisciplinary team of doctors to determine other appropriate therapy. However, as technology and knowledge develop, the criteria for patients who qualify for surgery can be expanded depending on the strategy of the team of doctors who handle them. For example, in patients who have large liver tumors, calculation of liver volume is a challenge. Detailed analysis from the team of doctors, accuracy, as well as patient preparation and supporting equipment will determine the success of the operation.
The doctor must calculate the tumor size, incision margins, and remaining liver volume with greater precision. Calculation of the remaining healthy liver volume and tumor size is assessed radiologically via CT scan or MRI with angiography. We also needed intraoperative ultrasound to define the resection margins and the path of the cut with certainty. With accuracy in determining the boundaries and paths of cuts, more healthy liver tissue can be preserved.
What are the challenges in treating liver cancer in Indonesia?
Indonesia already has the capability and modern technology to handle surgery for liver cancer. Today's operations are supported by high-tech tools such as CUSA (cavitron ultrasonic surgical aspirator) to cut liver tissue without damaging the blood vessels and surrounding healthy tissue. With this tool, surgery to cut the tumor can run with minimal bleeding ( minimum bleeding) because it does not damage the blood vessels.
In some cases, surgery can also be done using a laparoscopic technique or surgery with minimally invasive techniques. So in terms of capabilities, both in surgery and palliative therapy, it can be said that Indonesia is comparable to developed countries. It is also not uncommon for cases of patients who return to Indonesia after not being successfully treated in other countries, we have managed to handle them with good results.
Unfortunately, many patients come with advanced cancer conditions that are difficult to cure. Whereas ideally cancer is diagnosed and treated quickly with appropriate therapy. In the cases that I often encounter, patients are less aware of their health condition. Not a few underestimate minor complaints such as bloating or mild stomach pain that often comes and goes.
Statistically, 30% of liver cancer patients who come still meet the criteria for surgery. The rest are advanced stage patients and can no longer undergo surgery so they fully receive palliative treatment . Another challenge in treating liver cancer in Indonesia is the scarcity of experts in liver surgery.
That's a bit about the challenge of surgery as a curative treatment of liver cancer, knowing all about this can help you and your loved ones to get the right treatment for optimal recovery if you are diagnosed with liver cancer. Don't forget to consult your liver problems with a trusted doctor.
This article was written by dr. Tjhang Supardjo , M. Surg, FCCS, Sp.B, FCSI, FInaCS, FICS who is a Surgical Specialist (Heart Disease, Gallbladder, Spleen and Pancreas) at OMNI Hospital Alam Sutera.
Dr. Expertise Tjhang Supardjo, M. Surg, FCCS, Sp.B, FCSI, FInaCS, FICS
- Treat liver disease & cancer
- Treat pancreatic disease & cancer
- Dealing with diseases, stones & bile cancer
- Treat spleen disease
- Laparoscopic surgery (minimally invasive technique)
- TACE/ TACI/ PTCD/ RFA/ Liver Dialysis
- Liver transplant
Education Dr. Tjhang Supardjo, M. Surg, FCCS, Sp.B, FCSI, FInaCS, FICS
- Doctor Profession, Faculty of Medicine, Trisakti University, Jakarta
- General Surgeon, Zhejiang University, Hangzhou, China
- Hepatobiliary-Pancreatic Surgery & Liver Transplantation Subspecialty, Zheijiang University, Hangzhou, China
- General Surgery Adaptation, UNPAD-RSHS Bandung
- Hepatology Institute, Eastern Hepatobiliary Hospital (EHBH) Shanghai, China
- Hepatobiliary Interventional Center (TACE, TACI, PTCD, RFA), Zhejiang University, Hangzhou, China
- Artificial Liver Supporting System (Liver Dialysis) Center, Zhejiang University, Hangzhou, China
- Living Donor Liver Transplantation, ASAN Medical Center, Seoul, Korea
- Pancreatic Cancer & Surgery, Kyoto University, Japan
For further information, contact Andy: +62 811-1225-277