Appointment Timing - 9am to 6pm
Liver & Pancreas Clinic
Giant Liver Tumors
Tumors in liver smaller than 5 cms in size are rarely difficult to handle during surgery. Tumors more than 5 cms are considered large & can prove tricky to operate depending on their location, liver size & liver function. Tumor s’more than 10 cms in size however are often referred to as Giant tumors at many places in literature for a reason. They need a special mention due to challenges associated with their management related to their size & location, the need to leave adequate liver behind (function & volume of remnant liver), possibility of intraoperative (bleeding) & postoperative complications (bile leak, bleeding, liver insufficiency, infection)
Giant liver tumors can include benign liver tumors like hemangioma or malignant tumors (cancer) like Hepatocellular cancer, cholangio carcinoma, metastasis (tumor spread from elsewhere) from neuroendocrine tumor or from colorectal cancer. Apart from these there can always be some uncommon pathologies.
The primary treatment for such tumors is surgery and resection completely whenever feasible. However very few patients with giant liver tumors remain eligible for surgery due to small volume of remaining liver &/or poor function (cirrhotic liver). Hence literature remains limited on large reviews and there are limited number of surgical teams with adequate expertise. Depending on tumor location various types of liver resections are planned and executed. In very selected patients liver transplantation is an option too.
When surgery is not an immediate viable option, an attempt is made to shrink the size of tumor by blocking its blood supply (transarterial embolisation -TACE or TARE) or chemotherapy. This may or may not be followed by surgery. If remnant liver size & function are an issue an attempt is made to augment both size and function of Nontumor bearing liver by blocking venous blood supply to tumor bearing part of liver (PVE) with or without blocking its venous drainage too, thereby increasing nutrition and blood flow to the remnant liver. If remnant liver size and function improves to desired level, surgery is considered. Sometimes sequential surgeries are carried out (TSH, ALPPS) to increase the safety of the procedure and outcome. Due to the complex nature of management of these tumors, giant tumors are be managed only at highly experienced centers.
We already have good experience of managing giant liver tumours & recently managed 2 more interesting cases of giant liver tumours with complications including a HCC with tumor in portal vein and a case of cholangio carcinoma with bile duct obstruction.
The 1st one is a case of hepatocellular carcinoma almost 12 cms in size with extension of tumor in the main vein carrying blood towards liver (portal vein). The patient was a 72 year old gentleman but very fit for his age and disease. After carefully working him up for a possible surgery we found him suitable for surgery and planned to do an extended resection of left half of liver along with part of right liver (since the tumor was protruding into the right half), along with extraction of the tumor thrombus (clot) from portal vein followed by a reconstruction of portal vein. It was a long & arduous 10 hour surgery. Patient gradually recovered over next 3-4 weeks. Such surgery has its own problems like bile leak, which did happen in this gentleman. However it was controlled with medical treatment & percutaneous intervention and patient was successfully sent home. This is the advantage of managing patients in centre with multidisciplinary team.
The second patient is a young lady in her forties with 11 cm tumor in her liver. She was diagnosed with the cholangio carcinoma in another place 4 months prior to coming to us. However was subjected to chemotherapy instead of surgery. Since she wasn’t operated in time at the previous hospital, she developed jaundice with tumor progressing inside the bile duct. When she finally came to us almost 4 months after initial diagnosis she had multiple bile drainage tubes inserted in her liver that were blocked, infected bile & resistant sepsis. After stabilisation we replaced her tubes to control infection and jaundice. Later she underwent a 10-11 hour surgery like the previously mentioned patient wherein we removed an extended left portion of liver and the entire bile ducts except those draining the right remaining lobe. These remaining ducts (total 4 different openings) were joined sequentially to an isolated limb of small intestine for bile drainage. She took more than a month to recover from the surgery due to highly resistant infection in the bile and was successfully discharged.
These 2 cases demonstrate the challenges involved in the management of giant liver tumors and further bolstered our confidence of handling such complex cases through multidisciplinary involvement.
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Address: Lilavati Hospital, A-791, Bandra Reclamation Rd, Bandra West, Mumbai, Maharashtra 400050
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Timing: Saturday 9am To 10am
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Address: 93, ACI Hospital, 95, August Kranti Rd, Kemps Corner, Cumballa Hill, Mumbai, Maharashtra 400036
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Address: Raheja Rugnalaya Marg, Mahim West, Mahim, Mumbai, Maharashtra 400016
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