Complex surgery of the liver, pancreas and bile ducts is done at relatively few centers. Unfortunately there is a tendency of surgeons and physicians who are not familiar with what is possible to tell patients with large liver, bile duct or pancreatic tumors that they have incurable disease and referring them for palliative chemotherapy. Many of these patients can be cured by appropriate surgery. We describe some examples here.
A Large Liver Tumor
This patient had a very large liver tumor. The tumor was compressing the vena cava (the main vein which carries blood from the abdomen and legs back to the heart) and causing congestion and failure of the kidneys. He had been turned down for surgery at several other centers before he came to us.
We suggested surgery as all other options would not have been curative. There was a somewhat higher risk of surgery since the kidneys were not working properly.
After 12 hours of surgery, the tumor is removed. It weighed 3.3 Kg, about the size of a large newborn baby.
The patient went home after one week. His kidneys recovered and he is doing well.
A pancreatic tumor involving the portal vein
This 65 year old lady had a large tumor in the head of the pancreas involving the portal vein (a large vein carrying blood from the intestines and spleen into the liver). Most such patients are referred for chemotherapy. They suffer the side effects of chemotherapy for a minor extension of life span which is rarely more than 3-6 months. However, surgery with reconstruction of the vein can cure the patient.
The CT scan shows a long segment of the portal vein involved by the tumor in the pancreas.
The blue slings are used to control the portal vein (left), the superior mesenteric vein (right) and the splenic vein (above). In between is the tumor engulfing the vein.
The tumor was removed along with the segment of the vein and the superior mesenteric vein joined end to end to the portal vein.
The tumor was removed intact with all margins free. The patient went home in one week and is doing well.