New Minimally Invasive Approach for Liver Tumour Surgery in Cirrhosis Patients

The risk of developing liver cancer is increased in people who have cirrhosis, a disease in which healthy liver tissue is replaced by scar tissue. The scar tissue blocks the flow of blood through the liver and keeps it from functioning as it should. Patients with advanced liver cancer and cirrhosis are usually considered unsuitable for surgery or transplant.

A new study published in the British Journal of Surgery describes successful tumour removal using immunotherapy and targeted radiation therapy (TARE) in a patient previously deemed ineligible for the procedure.

Corresponding author Eduardo Vega, MD, assistant professor of surgery at Boston University Chobanian & Avedisian School of Medicine, explains, “Our study describes how a minimally invasive surgical approach known as the Arantius-first technique can be applied in high-risk populations, potentially expanding surgical indications for patients with cirrhosis.”

The Arantius-first technique is a laparoscopic procedure that uses the Arantius' ligament as an anatomical landmark to swiftly expose the middle hepatic vein (MHV). This method allows the surgeon to quickly and accurately locate the MHV, one of the liver's major vessels. In conventional approaches, there is a higher risk of split injuries or iatrogenic damage to the MHV, which can lead to severe complications, particularly in patients with cirrhosis who have limited functional liver reserve.

By focusing on this landmark, the Arantius-first technique minimises the risk of injuring the MHV and ensures its preservation, which is critical during a left hepatectomy in cirrhotic patients. This precision not only enhances the safety of the procedure but also contributes to better patient outcomes.

The care for this patient involved multiple steps. First, the tumour was treated with TARE, a targeted radiation therapy that reduces tumour size while sparing healthy liver tissue. Next, immunotherapy was used to boost the immune system's ability to fight the cancer. These combined treatments transformed the tumour from unresectable to resectable. Finally, laparoscopic surgery was performed using the "Arantius-first" technique, which allowed for precise tumour removal while minimising harm to the remaining liver.

According to the researchers, this study highlights the importance of collaboration across disciplines, with surgeons, oncologists, and radiologists working together to achieve exceptional outcomes.