Non-Resectional Therapy
The liver is an organ that both fascinates and frustrates surgeons caring for patients with liver cancer. The liver is fascinating because it regenerates itself after part of it is removed. This does not mean that after removing a segment or lobe of the liver, a new segment or lobe grows back. Instead, the remaining liver enlarges to occupy the space vacated by the removed piece of liver. As surgeons, we take advantage of the fact that the human body is "over-engineered", meaning we can remove portions of an organ like the liver because we know there is enough remaining liver to carry out all the necessary organ functions. In people with a normal, healthy liver, we can remove up to 75% of the liver and the remaining 25% is enough to carry on the normal functions of the liver. In patients with certain types of liver cancer, surgical removal of the portion of the liver containing the cancer is the treatment option with the best chance of curing the patient. One frustrating part about liver surgery is that most patients with liver cancer can not be treated with surgical removal of the cancer. Surgical removal of the cancer may not be possible because
- there are too many malignant (cancerous) tumors in the liver,
- the cancer is located in the center of the liver near the blood vessels carrying blood in and out of the liver, making it impossible to remove the tumor without damaging the vital blood vessels,
- the malignant tumors are in both sides, or lobes (there is a left and a right lobe of the liver), of the liver, making it impossible to remove the tumors while leaving an adequate amount of normal liver to carry out necessary functions,
- the liver itself is diseased, or unhealthy, typically because of cirrhosis caused by hepatitis B or C virus infection or alcohol abuse, which is a problem because cirrhotic livers may not regrow or function adequately after a piece of liver is removed, and
- the cancer has spread to other organs or areas outside the liver, indicating that surgical removal of part of the liver will not rid the patient of their cancer, and thus, liver surgery will not cure, and probably not even prolong the life of the patient.
A second great frustration faced by liver surgeons is that we can remove or destroy only those cancers we can detect; even in those patients who undergo a successful operation to remove or destroy liver cancer, the cancer may come back in the remaining liver or in another organ. This indicates that there were tiny, or microscopic, areas of cancer cells present at the time of the liver operation that eventually grow large enough to be detected on imaging (X-ray) or laboratory tests.
When a patient is diagnosed with primary or secondary (metastatic) liver cancer that is only in the liver, but surgical removal of the cancer is not an option because of one or more of the reasons listed above, there are several other treatment options that may be considered. Whether any, or all, of these options are appropriate or applicable should be discussed with the team of physicians. The basic principles, advantages, and potential complications of the following treatments should be understood and the pros and cons can be weighed to make an informed decision. It is important to know that these treatments are designed to treat only tumors in the liver. Thus, these treatments will generally be used if there are tumors only in the liver (no spread to other areas of the body).
