University of Cincinnati (UC) surgeon recently performed what is
believed to be the world’s first pediatric laparoscopic liver surgery,
a specialized procedure for removing cancerous liver tumors without the
need for a major incision.
Thomas, MD, an assistant professor and transplant surgeon at UC,
performed the operation in a 2-year-old boy with liver cancer on May 24
at La Raza Pediatric Medical Hospital in Mexico City.
cancer is rare in children—less than 150 cases are diagnosed each year
compared to more than 18,000 in adults—so the disease often
misdiagnosed as constipation, food intolerance or anorexia until it is
in advanced and difficult-to-treat stage.
patient’s symptoms had been dismissed as such for several months before
physicians confirmed he had hepatoblastoma of the liver, a type of
cancer that starts in the organ’s cells (hepatocytes) and develops into
one or multiple tumors. Thomas was invited to the La Raza Pediatric
Medical Hospital to perform the patient’s surgery and teach two
lectures on the specialized minimally invasive procedure.
(minimally invasive) surgery is a method of operating inside the
abdomen through small, tube-like ports using a fiber-optic light
source, camera and specialized instruments. Known as laparoscopic liver
resection, this procedure requires incisions so small (about
three-inches) that they leave only minimal scarring.
months post-surgery, the patient is doing well and is expected to have
a full recovery after several additional rounds of chemotherapy.
says the procedure is a safe, effective alternative to traditional
“open” surgery for liver cancer—which requires up to a 30-inch
incision. It also is available for patients with advanced liver disease
who cannot tolerate the standard operation. The minimally invasive
laparoscopic approach is most often used to remove liver tumors and
treat other liver diseases.
liver resection results in less pain and faster recovery times for
patients,” Thomas explains. “Adult patients can usually start eating
again a day after surgery and are back to work within one or two weeks.”
“Now we’ve shown that the same procedure can improve survival for patients with childhood liver cancer,” he adds.
says the laparoscopic liver procedure has the same success rates as
traditional open surgery and the patient usually goes home within two
liver, one of the body’s largest organs, helps metabolize food and
medicine absorbed from the intestines in the blood supply, produces
bile to help digest fats, and stores energy-producing glycogen (sugar).
liver cancer—which grows from within the organ as opposed to spreading
there from another area of the body—is rare. In adults, the most common
type of primary liver cancer is hepatocellular carcinoma (HCC) and in
pediatric patients it is hepatoblastoma. Both develop from hepatocytes
and can occur as one or multiple tumors. HCC accounts for 80 percent of
all primary liver cancers. Colorectal, breast and gastric cancers also
commonly spread to the liver.
perform the laparoscopic liver procedure, carbon dioxide gas is pumped
into the patient’s abdomen to increase the operative area and improve
visualization of the tumor. The surgeon then makes two to four small
incisions on the right side of the rib cage to accommodate the
laparoscope, a tiny “telescope” equipped with a camera, and other
specialized surgical instruments. The surgeon then severs and ties off
tumor’s blood supply, cuts out the tumor itself, places it inside a
sealed bag, and removes it through one of the incisions.
liver is a self-healing organ,” explains Thomas, “so once the cancerous
tumor is removed the area typically heals within two to four weeks.”
suggests that cirrhosis, a condition that results in scarring of the
liver tissue and long-term hepatitis B and C infections, can increase
the risk for liver cancer. People who abuse alcohol, smoke cigarettes
or are obese are also at an increased risk for the disease.
and his team perform about 250 laparoscopic liver cases a year.
According to a literature review, there are no published reports of
laparoscopic liver resection in a pediatric patient with cancer.
“Only a handful of centers in the world perform the number of specialized laparoscopic liver surgeries that we do in Cincinnati,” adds Thomas.
American Cancer Society estimates that about 18,000 new cases of
primary liver cancer and bile duct cancer will be diagnosed in the United States
during 2006. Because of a higher incidence rate of hepatitis B and C,
liver cancer is more common in developing countries in Africa and East
Asia than in the United States.
For more information on laparoscopic liver surgery, visit www.lapliver.com.