Photo: The Paper

A surgical team at a Shanghai hospital successfully performed the world's first innovative liver surgery on a 36-year-old patient with multiple colorectal cancer liver metastases, according to media reports on Wednesday, while a medical expert told the Global Times on Thursday that this is one of the most complicated surgeries, creating opportunities and hope for more patients.

The team at Zhongshan Hospital affiliated to Fudan University used the waste liver for transplantation combined with a two-stage procedure, called associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), which is developed for patients with an excessive number or volume of liver tumors and insufficient volume of liver remaining after tumor resection.

According to the report, some patients with growing benign liver tumors close to or encircling large blood vessels require partial resection of the normal hepatic lobe tumor to ensure surgical safety. However, the resected liver lobes, which in the past were usually considered medical waste or used only for basic research, can be used as functional liver tissue for transplantation by preserving specific blood vessels and biliary tract.

In the first stage, the surgeon isolated the right and left halves of the patient's liver and resected the left lobe of the diseased liver, which was riddled with 10 metastases, according to media reports. Doctors then transplanted a discarded part of the left lobe for the patient, and ligated the right branch of the portal vein of the diseased liver.

The surgical team has to accurately measure and regulate the blood flow and pressure in the left side of the portal vein in order to ensure that the second stage of the procedure went smoothly. According to the report, the implanted waste liver grew rapidly, increasing in size by about 70 percent, and was fully capable of performing the physiological functions of the patient's liver.

The liver has a relatively high regenerative capacity, and in principle only 30 percent of a normal liver can maintain the normal functions required by the human body, Zhuang Shilihe, a Guangzhou-based medical expert, told the Global Times on Thursday. However, ALPPS can be used for some patients who depend on chemotherapy which cannot achieve a curative effect.

Hepatobiliary and pancreatic surgery has already been regarded as the most complex procedure in general surgery due to its structural complexity. This surgery, considered as the largest and most complex surgery within the field, also demands a high level of skill from the surgeon and requires an extremely precise preoperative assessment, Zhuang added.

Prior to the surgery, the patient had undergone a colon cancer resection, 28 chemotherapy treatments and an interventional chemotherapy treatment, the report said, and metastases throughout the patient's liver have become progressively resistant to chemotherapy drugs.

The patient recovered well in all aspects after the surgery. 21 days later, she received preventive chemotherapy, and then she was discharged from the hospital.

Zhuang said that the procedure has brought hope to some patients. However, this surgery is not suitable for all patients, including those with more lesions and don't have suitable waste liver, the elderly and people with poor liver function. This procedure is also demanding on the patient's vascular situation.

Liver is one of the common sites of metastasis from colorectal cancer, and liver transplantation becomes a treatment for many patients who are unable to undergo radical hepatectomy, according to the report, but liver sources for transplants in China are still in very short supply.