5 hours of "breath-holding" to remove a 1.5kg liver tumor

(Dan Tri) - After 3 hours of meticulous surgery, the doctors reached the tumor. A consultation was held right on the operating table to find the safest surgical option for the patient.

After a thorough examination, Mr. An (name changed), 51 years old, living in Hai Phong , was taken to the operating room.

Two months ago, Mr. An was admitted to the Department of Hepatobiliary - Digestive and Oncology Surgery, Central Hospital for Tropical Diseases, with a diagnosis of right liver cancer and heart failure due to an untreated coronary infarction.

2 months of preparation for the decisive battle

"The patient faced many intertwined problems, especially the large right liver cancer mass, with no radical solution other than resection.

The volume of the remaining left liver is quite small, the risk of liver failure after surgery is almost certain. The patient has heart failure with a left ventricular ejection fraction (EF) of only 33% (an index showing the heart's ability to contract, normal people must have at least over 50% - PV)", Dr. Nguyen Truong Giang, Department of Hepatobiliary Surgery - Digestive & Oncology, informed.

According to doctors, an optimal solution to immediately solve liver cancer is impossible. This is a very long battle for patients as well as doctors.

The patient faced many intertwined problems, especially the large right liver cancer mass, with no radical solution other than resection (Photo: Minh Nhan).

This expert analyzed that for patients with liver cancer and heart failure, liver resection will lead to the risk of heart failure and liver failure combined, making the patient susceptible to falling into a dangerous state.

Hepatic artery embolization is difficult to be effective because the tumor is large and protrudes beyond the liver capsule. Meanwhile, drug treatment "has not brought about any clear changes".

However, according to this expert, when there is a coordinated strategy between many specialties and treatment methods, the fight against cancer can take a different direction.

Before this surgery, doctors went through many "small battles" to gradually increase their chances of winning.

The patient was examined and treated with cardiovascular drugs at Hanoi Heart Hospital with an expected significant improvement in heart function after 3 months. The patient was then transferred to the Diagnostic Imaging Center, Viet Duc Friendship Hospital for portal vein and right hepatic vein embolization to enlarge the left side of the liver after 3-4 weeks.

At the same time, doctors also blocked the artery supplying blood to the patient's tumor to control its growth in the meantime.

The doctor explains to the patient's family about liver removal before surgery (Photo: Thanh Dang).

After a month, the patient's heart function improved but the tumor still absorbed a lot of medicine, so the doctors decided to perform another embolization. "This embolization was quite intense, the patient was close to liver failure," Dr. Giang recalled.

Waited another 4 weeks, EF index has increased to 42%, although still low but at an acceptable level. Left liver size has almost doubled, enough for the body.

Although the tumor continued to grow, the doctors decided: That was enough preparation.

The clock has struck, the "war" begins

At 8:30 a.m. on June 27, the patient underwent surgery to remove his right liver. The surgical team consisted of 3 people, with Dr. Nguyen Truong Giang as the main surgeon. The anesthesia team consisted of 2 doctors and nurses.

The patient was fully examined for all health indicators. When he was sure he was fit for surgery, at exactly 9am, Dr. Pham Quang Vu performed the epidural analgesia and endotracheal anesthesia.

Epidural analgesia is used to create an area of numbness at the surgical site and help patients limit pain after surgery.

Meanwhile, endotracheal anesthesia is an anesthesia method used in complicated or long surgeries. This method ensures that the patient is unconscious during the surgery and does not feel pain.

The doctor applies antiseptic to the surgical area (Photo: Minh Nhan).

By administering anesthesia through the respiratory tract, the patient's breathing and blood pressure are maintained stable throughout the surgery.

After checking and determining that the patient's condition after anesthesia was secure, Dr. Giang began to open the patient's abdomen with an incision about 30cm long.

The doctor made the first incision and began the surgery (Photo: Minh Nhan).

The J-shaped incision allows for easier, more complete access to the organs and structures inside the abdomen. This technique provides enough space for surgeons to perform complex surgeries such as removing cancer cells.

The incision is made in a J-shape to provide comprehensive access (Photo: Minh Nhan).

To reach the tumor, doctors must open each layer of the patient's abdominal structure. Each incision requires high concentration, in order to limit invasion to surrounding tissues.

Each operation requires high concentration (Photo: Minh Nhan).

After 3 hours of meticulous surgery, the doctors reached the tumor. A consultation was held right on the operating table to find the safest surgical option for the patient.

After 3 hours of meticulous surgery, the doctors reached the tumor (Photo: Minh Nhan).

"Hepatectomy is a serious surgery, and it is performed on a patient with heart failure, so the risks during surgery are very high. It is necessary to avoid massive blood loss and massive transfusion beyond the heart's capacity," Dr. Giang emphasized.

A series of challenges are posed. Doctors must be extremely careful to avoid moving the liver, causing twisting of the hepatic pedicle and compression of the inferior vena cava, affecting blood flow to the heart.

Not only the surgeons, but also the anesthesiologists are closely monitoring the patient's vital signs. Every small change must be taken seriously because "a little mistake can lead to a thousand miles of bad luck".

Having decided on an emergency plan for the worst case scenario, the doctors continued to enter the battle of life and death. On one side was the patient facing death, on the other side were the "angels in white" trying their best every second, every minute.

With high concentration, skillful hands, careful in every action, eyes constantly following the indicators, the doctors and nurses gradually bring the patient step by step towards life.

The patient's vital signs are closely monitored (Photo: Minh Nhan).

At the beginning of the right hepatectomy, the surgeons performed cholecystectomy, dissection of the contents of the Glisson's capsule, and dissection of the right extrahepatic Glisson's pedicle.

After completing step one, the doctors continued to perform the liver suspension procedure, cutting the liver anteriorly along the right edge of the middle hepatic vein to the anterior surface of the inferior vena cava.

After completing the liver resection, the surgical team skillfully cut the Glisson pedicles of the anterior and posterior lobes, the caudate tubercle, ligated the short hepatic vein branches, and cut the right hepatic vein.

Right liver resection is a serious surgery, performed on a patient with heart failure, so the risk during surgery is very high (Photo: Minh Nhan).

Even though the surgery was in its final stages, the pressure of life and death still weighed heavily on the doctors' operations. The concentration was clearly shown through the doctors' eyes.

"Last minute does not mean success. Patients with heart failure always face the threshold of death on the operating table, requiring us to not lose focus. If any small mistake occurs, the price to pay could be the patient's life," said Dr. Giang.

Last minute does not mean success (Photo: Minh Nhan).

The decisive step came, the surgeons released the right liver from the patient's abdominal wall. Then, the surgical team placed 2 electric liver drains before completing the surgery.

The war is not over yet

After 5 hours of intense surgery, Dr. Giang tied the last stitch to end the surgery. The liver tumor that was safely removed weighed 1.5 kg.

The liver tumor removed weighed nearly 1.5kg.

At 2:00 p.m., the door to the operating room gradually opened, and the doctors in their signature blue surgical gowns stepped out, breathing a sigh of relief.

"If you ask me if this surgery was dramatic, spectacular, fierce, involved a lot of blood loss, or how it was handled, I can only smile," Dr. Giang shared after the surgery.

"The difficulties have been handled by my colleagues for several months now, my job is just to be careful not to sabotage their achievements," he said.

The expert stressed that sometimes careful preparation is more important than the surgery. He cited the old saying: "Seek victory first, then seek battle."

Cancer treatment is a multidisciplinary process and requires a long-term strategy. Complex cases can take months to complete, involving multiple disciplines. In addition, the treating physician must look beyond his or her own area of expertise to find the right solution.

The surgery is over, but the patient and doctors still have a long battle ahead. "Our job is to prepare for the fight as best we can," said Dr. Giang.

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