The conventional approach to surgically treating liver tumors presupposes the removal of an important part of the healthy tissue. Thanks to the work of Professor Guido Torzilli, Director of the Department of General Surgery and the Division of Hepatobiliary Surgery in Humanitas, and his team, today there are different procedures that allow you to preserve the liver as much as possible and operate on patients who previously could not be subjected to surgery.
“Almost twenty years ago I developed a surgery to detach tumors from large intrahepatic vessels, which recently, together with my group, showed that it has no greater risk of leaving patients with disease than it does in patients where this surgery was not necessary. This new surgical horizon has allowed otherwise inoperable patients to be able to undergo surgical treatment and therefore to move from a palliative to a curative perspective,” explains the professor.
The Hepatic Tunnel
“Thanks to this new surgical horizon, together with my group I have developed new oncological appropriate procedures that can offer surgical treatment to patients who would otherwise not be able to undergo surgery and proposed them to the international surgical community. Among these, there is the hepatic tunnel: initially described from the technical point of view on The Annals of Surgical Oncology in 2014, is now being published in the most prestigious magazine of surgery to date, The Annals of Surgery, reporting on the experience of the first 20 patients operated with this new type of surgery. A new operation that has been reached in small steps, developing over the years through increasingly complex interventions for which the tunnel is a piece of cake, and all have proved their validity for situations that are increasingly complex and otherwise not manageable surgically.
With the tunnel it has been possible to standardize the selective removal of tumors that have unfortunately grown right in the center of the liver, imprisoned by the blood vessels that carry in and out the blood that passes through the organ. Tumors considered irremovable until now, if not through interventions that involved the removal of the organ from the patient’s body, which is burdened by high mortality rates, have never found a definitive standardization in clinical practice. At the end of the procedure there is an empty cylindrical space that crosses the liver from top to bottom, which remains perfectly functional with the vessels that surrounded the tumor(s), at first appearing as prison bars and now walls of a real tunnel.
The vessels (superhepatic veins) involved are those that unload the blood of the liver into the large vein that then takes it to the heart (lower hollow vein), those that carry the blood into the liver (glissonian peduncles) and the lower hollow vein precisely to which the liver is clinging,” says the professor.
Natural bypasses
If one of the prison vessels is not detachable because it is almost closed by the tumor, the adaptation of the liver to this condition is exploited. A prerogative of this complex and fantastic organ, previously demonstrated by Prof. Torzilli: “When the tumor does not acutely close one of the three veins that discharge the blood of the liver into the heart, they open a bypass in the organ between the invaded vein and the veins that are next to it. Thanks to ultrasound scanning it is possible to find these bypasses and preserve them during dissection. This is done by programming a resection area that passes carefully to the side of those bypasses. The intervention therefore creates a tunnel in the liver, letting the tumor “escape” and we achieve a liver free from the unwanted host, almost entirely preserved and fully functional,” concludes Professor Torzilli.
