Advanced Liver Surgery Requiring Large Vessel Resection and Reconstruction Lecture During the 2023 Society of Surgical Oncology Cancer Symposium

Liver tumors present in various types and sizes often involve vital structures inside and around the liver. In the past decade, many patients presented to Dr. Sucandy’s clinic with advanced stages, deemed nonresectable by other surgeons in other hospitals.

These patients had been evaluated for systemic chemotherapy and radiotherapy; however, their outcomes were anticipated to be very poor without definitive liver surgery. Without a surgical resection (open or robotic method), the overall survival is less than three to six months.

Three patients were evaluated for a 15cm intrahepatic cholangiocarcinoma involving the Inferior Vena Cava (IVC), the largest vein in the body. Intrahepatic cholangiocarcinoma is a type of aggressive cancer originating from the bile duct tributaries inside the liver. This tumor is often diagnosed late when it has invaded important vessels.

In these three patients, IVC invasion was the reason for unresectability by other surgeons in the Greater Tampa Bay area. IVC is a major vital blood vessel that brings blood from the lower body back into the heart. An inadvertent IVC injury generally leads to immediate exsanguination and death. Because of these reasons, a tumor near the IVC creates such high technical complexity.

After a proper preoperative evaluation, Dr. Sucandy and his team considered these cases to be resectable using advanced vascular resection and reconstruction techniques. The patients and their families understood the high-stakes nature of these operations. Knowing that the only chance for cure is through resection and major vascular reconstruction, an open liver operation was then planned.

Dr. Sucandy and his team began the operation by identifying and exposing the liver tumor (cholangiocarcinoma) while preparing the IVC behind the liver for the resection and reconstruction. The operations were very difficult, with large tumors to be manipulated.

The goal of the operation was to achieve complete tumor resection without leaving any cancer behind. The IVC was totally clamped for 30 minutes to allow for the IVC reconstruction using a synthetic Dacron vascular conduit.

Each of those three operations went very well, with minimal bleeding. The postoperative courses were uneventful without complications. The patients were discharged after five days of hospitalization.

The IVC resection and reconstruction technique is an important skill for an advanced liver surgeon like Dr. Sucandy. The majority of cancer surgeons and pancreatic surgeons do not have the skillsets to do these operations. The patients were doing well without tumor recurrence even after four years following their index operations.

These cases and the surgical technique used were presented at the International Conference of Cancer Care in Boston, hosted by the Society of Surgical Oncology, a very prestigious society for cancer surgeons in the Americas. Hundreds of cancer surgeons and trainees learned this technique from Dr. Sucandy and his team to help other patients with similar circumstances.

Finding an experienced liver surgeon in your area to treat liver tumors is crucial, which may need advanced vascular reconstructive techniques. and his team in order to help other patients with similar circumstances.  It is crucial to find an experienced liver surgeon in your area for treatment of liver tumors, which may need advanced vascular reconstructive techniques.