Canadian surgical first to remove cancer from the liver

A new surgical option to remove cancer from the liver has been performed for the first time in Canada at London Health Sciences Centre (LHSC).

On April 23 Dr. Roberto Hernandez-Alejandro, Schulich Medicine & Dentistry Assistant Professor, completed the first of a two stage surgery to remove cancer from the liver. The second stage of the surgery was completed May 1.

Formally called an associating liver partition and portal vein ligation for stage hepatectomy, or ALPPS procedure, the surgical first is that both stages of the hepatectomy, or removal of the liver, are completed in one week to ensure that cancer does not spread to other parts of the liver.

"During the first surgery, the surgeon first removes tumours in the left side of the liver and then cuts the blood supply to the right side of the liver. Without blood flow, the right side of the liver shrinks, and the left side of the liver grows exponentially due to excess blood flow," describes Dr. Hernandez-Alejandro. "After one week, the surgeon then performs another surgery on the patient to remove the right side of the liver, and therefore all cancer from the liver."

Dr. Hernandez-Alejandro has operated on four more patients using the groundbreaking surgical technique since the first surgery on April 23. Each patient has varied, but typically the left side of the liver has grown between 70 - 80 percent of the full size of a healthy liver within eight weeks of the surgery and maintains full liver function.

Patient Richard Brunet, 66, from London, Ontario was the second patient to undergo the surgery and has recuperated well. "I retired in 2007 and my health derailed some of my retirement plans, but I'm now hoping to travel with my wife and play golf fairly soon."

"Because patients must undergo two surgeries in seven days, something not typically done, they must be relatively fit to qualify for this procedure," continues Dr. Hernandez-Alejandro. "A comprehensive medical assessment including an evaluation of cardiac function and history, pulmonary function, and an assessment by an anesthetist ensures only the most suitable patients are selected for surgery."

The selection criteria for this procedure also translates to a shorter hospital stay. Brunet spent 17 days in hospital, and other patients have been discharged from hospital within four weeks from the time of their first surgery.

Dr. Hernandez-Alejandro has been invited by hospitals across Canada to share his expertise and recently presented at the American College of Surgeons Annual Meeting in Chicago.