Q&A: Liver-Hanging Surgical Procedure

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By Dawn Dorsey, Staff Writer

Surgical removal of a tumor close to or connected to the liver creates risks that the patient will have severe blood loss or the tumor will spill into other areas.

A surgical procedure in which the liver is placed in a sling, also called a liver-hanging procedure, is performed at M. D. Anderson. This approach, specifically designed for removal of large tumors in the upper right abdomen, reduces these risks.

Jean-Nicolas Vauthey, M.D., professor of surgery and chief of the Liver Service in the Department of Surgical Oncology at M. D. Anderson, developed the procedure and answers questions about this surgical approach.

What is the liver-hanging procedure?

Using a blunt instrument designed for pediatric surgery, we can safely develop a space between the major vein of the body, the vena cava, and the back of the liver. Then the instrument can be safely advanced behind the liver, and a sling can be passed through the space. The sling is used as a guide to cut the liver safely with minimal bleeding. This can be accomplished while the major vein is protected.

For which types of tumors is this procedure used?

The liver-hanging maneuver can be used for large tumors in the upper right abdomen of the body, specifically tumors attached to the liver. A person does not have to have liver cancer to have the surgery.

We have used this surgery with:

•    Liver cancer
•    Adrenal cancer
•    Colorectal cancer
•    Neuroblastoma
•    Renal cell carcinoma
•    Large stromal tumors

What is the benefit of the liver sling?

With this procedure, we have seen a reduction in bleeding and occurrences of tumor rupture. Fewer patients have had tumor recurrences.

In patients who had the liver-sling surgery:
None had tumor rupture during surgery. Without the sling, 12% of tumors rupture.
The cancer returned in 38% of cases. It returned in 69% of patients who had other surgeries.
Less blood loss occurred.

How is this procedure different from the regular surgical approach?

Before, large incisions had to be made in the chest for adrenal carcinoma and some other types of cancer. This procedure doesn't involve cutting the diaphragm, which is a huge advantage.

What is the history of the procedure?

Doctors in France and China have used similar procedures, and I modified their approaches to focus on large tumors in this area.

The first liver-hanging surgery was performed at M. D. Anderson in 2003, and since then about 40 patients have benefited from it.

Why isn't it used with small tumors?

Because small tumors don't stick to the liver, they pose less risk than larger ones.

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