Rare two-stage liver surgery gives new lease of life to 61-year-old Kenyan patient

According to experts, in most cases of primary liver tumours with chronic liver disease, surgical removal is complex, as the remaining liver is often too small or compromised to meet metabolic demands post-surgery.
| Photo Credit: mathisworks

A 61-year-old patient from Kenya suffering from advanced liver cancer complicated by chronic hepatitis B got a new lease of life following a rare two-stage liver surgery at a private hospital in the city.

The patient, diagnosed with a large hepatocellular carcinoma in the right lobe of the liver, faced significant challenges due to underlying fibrosis from hepatitis B. According to experts, in most cases of primary liver tumours with chronic liver disease, surgical removal is complex, as the remaining liver is often too small or compromised to meet metabolic demands post-surgery.

A team of experts at SPARSH Hospital performed a two-stage liver surgery using an innovative technique called Associating Liver Partition with Portal Vein Ligation for Staged Hepatectomy (ALPPS),  This surgery stimulated rapid liver growth allowing for the safe removal of the malignant portion of the liver.

Without the ALPPS technique, the risk of post-hepatectomy liver failure (PLF) was high. However, with ALPPS, doctors enabled rapid liver regeneration to make surgery viable. 

Cancer and fibrosis

Vikram Belliappa, Senior Consultant Gastrointestinal and Liver Transplant surgeon at the hospital said the patient’s liver was not only affected by cancer but also compromised by fibrosis, making conventional surgery extremely high-risk. “ALPPS allowed us to bypass this risk by promoting rapid growth of the remaining liver segment before the tumor was removed,” he said.

Explaining that the ALPPS procedure was executed in two critical stages utilising the advanced technique of 3D reconstruction using 3D printing, Dr. Belliappa said: “The whole surgery was planned using 3D imaging and 3D printing so that exact volumes of the liver could be calculated and surgery could be virtually planned. Utilising specialised software and medical grade 3D printers a model of the liver and the tumour was created which helped in executing this complex surgery.” 

“In the first stage, we ligated the portal vein supplying blood to the tumour-bearing section of the liver while creating a partition within the liver itself. This redirected all blood flow to the portion of the liver that would remain, stimulating accelerated hypertrophy (growth). Following this stage, advanced 3D imaging showed that the liver remnant had nearly doubled in size from its original volume of 350cc to an impressive 620cc within seven days, sufficient to manage the patient’s metabolic needs,” Dr. Belliappa explained.

Second surgery after ten days

Stage II involved another surgery. Ten days after the initial surgery, the team performed an extended right hepatectomy to remove the tumor-bearing section of the liver. The newly hypertrophied liver remnant successfully handled the body’s metabolic demands, and the patient recovered well, leaving the hospital in a stable condition after one-week post-surgery. 

“This innovative approach and novel procedure leverages the liver’s natural regenerative capacity, allowing us to safely perform surgery on patients with liver cancer complicated by chronic disease,” the doctor added.