The conventional approach to treat surgically liver tumours requires the removal of a big portion of healthy tissue. Thanks to the work of Professor Guido Torzilli, Director of the Department of General Surgery and the Division of Hepatobiliary Surgery at Humanitas, and his team, nowadays there are many procedures that allow for the conservation of as much liver as possible. In fact, they also allow surgeons to operate patients that up until now could not undergo surgeries.
“Almost twenty years ago, I developed a surgical technique to separate tumours from the big blood vessels in the liver. Recently with my team, we demonstrated that this technique does not pose a higher relapse risk for patients”, the professor explains.
This new surgical discovery allowed for the operation of patients who could not undergo other surgeries. Thus, moving from palliatives to a full-fledged healing treatment.
The Liver Tunnel
“Thanks to this new surgical discovery, my team and I developed and proposed to the international surgical community new procedures to be used against tumours, able to surgically treat patients that we could not operate in other ways.
Among these procedures, there is the liver tunnel. We described its technical details on The Annals of Surgical Oncology in 2014. Now, we will publish it on the most prestigious surgery journal, The Annals of Surgery. Additionally, we will mention the experience of the first 20 patients we operated this way. We created this surgical technique step by step, via the development of gradually more complex procedures during the years in order to treat situations that could not be tackled through traditional surgical means.
The tunnel standardizes the selective removal of tumours. These tumours have, unfortunately, grown right in the middle of the liver, trapped by blood vessels. Thus, we have always considered them as permanent. Accordingly, surgical operations that removed the organ from the body had very high mortality rates. That is the reason why they have never been standardized in the clinical practice.
At the end of the tunnelling procedure, an empty cylindric space remains in the liver, crossing it from top to bottom. The liver keeps working perfectly. Consequently, the blood vessels are now the walls of a tunnel, instead of the bars of the prison where the tumour was.
This procedure involves many blood vessels in the liver, the professor points out.
- The ones that deliver blood from the liver to the big inferior vena cava, that brings the blood back to the heart
- The ones that deliver blood to the liver (Glissonian pedicles)
- And the inferior vena cava, which the liver holds on to
If we cannot separate one of the blood vessels due to its position in respect to the tumour, we exploit the adaptation of the liver to this condition. This is a prerogative of this complex, fantastic organ, already demonstrated by Prof. Torzilli himself.
When a tumour obstructs one of the three veins that bring the blood back from the liver into the heart, the liver creates some bypasses between the invaded vein and the veins near it.
“An echography is able to locate these bypasses. Thus, surgeons may save them during the operation by programming a resection area around them. The surgery creates a tunnel inside the liver, removing the tumour and preserving the structure and function of the liver”, Professor Torzilli concludes.