Keyhole op to fight off the colon cancer invading your liver
FOR patients who have advanced colon cancer, the outlook was once bleak, but developments in scanning techniques and drug treatments mean that even those people whose tumours have spread may not be beyond help.
And now sufferers have been thrown another lifeline: doctors are trialling an innovative surgical technique to remove secondary cancers that have spread to the liver.
The keyhole operation means patients are required to stay in hospital for a few days rather than a week with traditional open surgery. A team at Southampton General Hospital is leading the way, treating more than 600 patients since 2007.
Although any liver tumour can be tackled, a significant number of cases involve colon cancer that has spread to the organ. However, removing them through the traditional open operation is risky as they are often large or close to an artery.
Liver surgeon Mohammad Abu Hilal, who has developed the minimally invasive approach, called laparoscopic liver resection, says although it takes longer and is more complicated than conventional surgery, the advantages are reduced risk of infection, speedier recovery and, in repeat surgeries, easier access.
Multiple surgeries are commonplace for colon cancer with liver secondaries (metastesies), but with it comes the complication of having to go through old scar tissue. Mr Hilal says: ‘Cutting through an old surgical wound can be difficult and they sometimes don’t heal well, which leads to complications for the patient and a longer recovery.’
Thanks to ‘smarter’ operations, experts even hope advanced colon cancer will become a disease that can be kept at bay by removal of tumours when they appear on the liver.
‘We are extending survival by treating it like a chronic illness that you can live with. We see a tumour, we go in and remove, and the patient is able to go home after a few days,’ explains Mr Hilal. ‘For a lot of patients we will treat them laparoscopically because it is convenient. If you have cancer that keeps coming back, you don’t want a major incision each time.’
Laparoscopic liver resection takes between three and seven hours under general anaesthetic. Several small openings are made, through which the surgeon uses instruments including a laparoscope – a thin tube carrying a camera that allows them to see and work inside the abdomen.
A larger cut is made close to the belly button through which the affected part of the liver is removed. The remaining liver can regrow – a unique aspect of the organ – within a few months of the operation, and can carry out all its normal functions.
Retired accountant Graham Coles, 63, from Watford, has had four keyhole liver surgeries with Mr Hilal since he was diagnosed with colon cancer. He says: ‘Soon after I’d had my initial colon cancer surgery at Oxford in March 2012, they found a tumour on my liver. I was expecting to face a conventional operation but then I contacted my daughter Sophie, who is a medical student at Southampton, and asked if she could help. By chance she had been working with liver surgeons and heard about the keyhole surgery.’
Sophie, 24, adds: ‘It was a complete coincidence that as part of my training, I had been in the liver department and heard this keyhole surgery described. I got back to Dad and told him I’d found the ideal surgeon.’
Graham had the first of his keyhole surgeries in September 2012 and has since had three more, the last of which was carried out in October. ‘Each time I have been out of hospital within three days and have been able to resume normal life,’ he reveals. ‘Being diagnosed with a recurrence of cancer is not good news. The only consolation is that I knew I would be having keyhole surgery – that made it more bearable.’
Graham’s last operation was more complex because the tumour was found on the back of what is known as the seventh segment of the liver. Mr Hilal says: ‘We had to use instruments to flip the liver over so we could see the tumour to remove it.
‘When I proposed doing keyhole surgery to remove liver cancers, I was told it was too difficult, but we have proved it can be done.’