A liver surgery first in SA

Posted on 26 November 2013

A new liver-surgery technique that promises an improved chance of survival for patients with metastatic (spread) cancer in the liver was recently performed for the first time in South Africa. The surgical team consisted of Dr Mark Hewat, a liver, pancreas and biliary specialist, and his team at Mediclinic Constantiaberg.

What does the liver do?
The liver has a great deal to do in the body: it’s thought to be responsible, in combination with other organs, for up to 500 functions. Of these, the most important are that it cleanses the blood, produces bile, which is important for digestion, and stores energy in the form of glycogen.

The cheering news is that it’s the only human internal organ capable of natural regeneration of lost or damaged tissue. With just 20-25% left, a liver can regenerate itself to perform the functions of the whole liver.

What is ALPPS?
Developed in Germany, the new technique is known as Associating Liver Partition with Portal Vein Ligation (Associated Liver Partition and Portal Sectioning) for Staged Hepatectomy (ALPPS). (A hepatectomy is the removal of part of the liver.) ALPPS is used specifically when only a very small section of the liver is cancer free, says Dr Hewat. At the initial surgery most of the liver, containing the cancerous growths, is separated from the small tumour-free section. The large piece is not removed completely during the first surgery, but the blood supply to it is partially blocked, which allows the large piece to continue to function, secreting growth hormones that stimulate the small tumour-free piece to grow.

The small piece grows rapidly, and after one to two weeks the large section is removed, leaving a functioning size of healthy liver. In the past there would not have been any curative option for a patient with such extensive metastatic disease. Instead, the Mediclinic Constantiaberg patient, a 49-year-old man, was discharged from hospital after the initial surgery and returned two weeks later for the second stage. He has since made an excellent recovery, and is settling in at home with his family.

Over the past three years, alongside the development of the GIT ward and new equipment at Mediclinic Constantiaberg, Dr Hewat has been building a team of surgeons, anaesthetists, physicians and nurses specialised in liver and pancreatic surgery.
It’s an encouraging outcome and another small victory in the fight against cancer.

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Published in Surgery

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