MINIMALLY INVASIVE OPTIONS World-class Team in Laparoscopic Liver Surgery
At Froedtert & The Medical College of Wisconsin, patients with liver cancer have access to a team of internationally known liver surgeons who have pioneered minimally invasive cancer surgery. T. Clark Gamblin, MD, MS, Medical College of Wisconsin surgical oncologist and chief of Surgical Oncology, wrote some of the earliest papers on laparoscopic liver surgery, and has taught the procedure on five continents.
“Minimally invasive surgery for liver cancer – as well as for small pancreatic tumors and early gallbladder cancers – offers patients faster recovery and less post-operative pain,” Dr. Gamblin said. Candidates are carefully selected based on the location, size and extent of their disease. “Approximately 15 to 20 percent of liver patients are eligible for a minimally invasive approach.”
T. Clark Gamblin, MD, MS
The liver team includes the robotic approach in its arsenal of minimally invasive options, even partnering with colorectal surgeons to treat liver metastases and primary colon cancer during the same operation.
Liver tumors that cannot be removed safely with surgery can often be treated with minimally invasive ablation techniques – using probes that destroy cancer cells with heat or cold energy. “The newest technology for liver cancer is microwave ablation, which involves a shorter time for the ablation,” Dr. Gamblin said. “We have completed almost 100 cases and are very pleased with the results for our patients.”
WhAT’S NExT: Minimally Invasive Isolated Liver Perfusion
Froedtert & The Medical College of Wisconsin are among just four centers in the United States that offer isolated liver perfusion (ILP), a method for delivering high doses of heated chemotherapy to the liver. Currently, ILP requires major open surgery. But a system recently approved in Europe could soon allow U.S. surgeons to perform ILP using catheters and other minimally invasive tools.
Interventional Radiology Delivers Innovative Therapies
Interventional radiologists specialize in using minimally invasive, image-guided technology. They play a key role in cancer care, because they are often able to deliver drugs and other therapies directly to tumors. These therapies usually have fast recovery times and preserve quality of life.
“Chemoembolization, used to treat a variety of liver tumors, is evolving and improving,” said William Rilling, MD, FSIR, Medical College of Wisconsin vascular and interventional radiologist. “We now use a catheter to deposit small beads loaded with large doses of chemotherapy directly at the site of the tumor.” A similar therapy called radioembolization uses beads impregnated with a radioactive substance. “A couple of years ago, we usually provided these therapies for patients who weren’t helped by chemotherapy and had no other options,” Dr. Rilling said. “Now, we integrate them earlier in the disease course.”
William Rilling, MD, FSIR
Combined therapies may also provide benefits. In a current clinical trial, patients with metastatic colon cancer receive chemoembolization or radioembolization between cycles of standard chemotherapy. A similar trial is available for patients with primary liver cancer. “We hope to use the strengths of both treatments for difficult diseases,” Dr. Rilling said.
In early studies, liver metastases from colon cancer responded to combined therapy at a higher rate than to chemo alone – about 90 percent versus 50 percent. “If that result holds up in larger studies, it will be a significant advancement.”
WhAT’S NExT: Irreversible Electroporation
For years, interventional radiologists have treated liver, kidney and other tumors using cold energy (cryoablation) and heat energy (radiofrequency and microwave ablation). Now, U.S. researchers are studying minimally invasive irreversible electroporation (IRE). “IRE probes deliver an electrical current that disrupts cancer cell membranes, causing cell death,” Dr. Rilling said. “We hope IRE will some day be used to treat organs like the pancreas where we can’t use heat or cold ablation.”
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