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Introducing Liver Surgery In Port Macquarie
 

Introducing Liver Surgery In Port Macquarie

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    Introducing Liver Surgery In Port Macquarie Introducing Liver Surgery In Port Macquarie Presentation Transcript

    • Introducing Liver Surgery to a Regional Hospital
      Port Macquarie Critical Care Conference
      Dr George Petrou FRACS
      Specialist Surgeon Port Macquarie Base Hospital
      69 Lake Rd, Port Macquarie NSW
      Hepatobiliary Surgery, Laparoscopic Surgery, Obesity Surgery, Endosurgery
    • Is there a need?
      Is it safe?
      Local expertise?
      Preliminary results?
    • Indications for liver surgery
      Colorectal metastases
      Hepatocellular carcinoma
      Cholangiocarcinoma
      Neuroendocrine tumours
      Hepatic sarcomas
      Some benign lesions
      Select metastases- breast, gastric, pancreatic, melanoma
    • Colorectal Cancer
      2nd most common cancer in Australia
      2nd cancer killer
      50% patients with colorectal cancer have or will develop liver metastases
      15% patients have liver mets at time of diagnoses of primary
      120 colorectal cancer resections performed in Port Macquarie per year
    • New Chemotherapy
      FOLFOX- median survival 24 months
      New agents are pushing this 2 year hurdle successfully
      FOLFIRI, FOLFOXFIRI
      +/- VEG inhibitors
      Now chemo alone med survival > 2 years
      5 year hurdle is only a matter of time
    • Selecting patients for liver surgery
      30% normal functioning liver remnant
      Patients eligible for surgery – 40-50%
    • Morbidity
      Morbidity 20-30%
      Bleeding 1-3%
      Bile leaks 10-30%
      Infection 10-30%
      Liver failure < 5%
      Wound problems 20%
      PE DVT 1-3%
    • Safe Despite Significant Morbidity
      Preoperative assessments of liver function
      Preoperative anaesthetic assessment
      Modern imaging- CT, MRI, PET
      Intraoperative ultrasound
      Post operatve anaesthetic and intensive care expertise
      Interventional radiology
      Surgical devices
      CUSA
      Staples
      Ligasure
      Argon
      Electrocautery
      Flowseal
    • Local Expertise
    • Our service in Port Macquarie
      Established GIT multidisciplinary team (Cancer Care Centre)
      Easily accessible high definition CT and MRI
      No PET- send to Sydney
      Established interventional radiology with experience in percutaneous drain placement
      Theatre team with experience in major vascular and GIT surgery
      Anaesthetic and ICU experience in major vascular and GIT surgery
      Established GIT medical oncology
    • Feb 2008-Oct 2009
      21Major liver resection completed
      4 Minor liver resections completed
      3 Major liver resections on waiting list
      CRC 12 (46%)
      Benign 10 (38.5%)
      Cholangiocarcinoma (8%)
      HCC 1 (4%)
      SI cancer 1 (4%)
      Median operating time 3 hrs
      Blood transfusions- 3 units packed cells (total)
      30 day mortality 1 (4%) Liver failure
      Post 30 day mortality 1 (4%) Pulmonary embolism
      Morbidity data and survival data- soon to be published
    • Summary Introducing Liver Surgery to a Regional Hospital
      Challenging but exciting time
      Enthusiastic and supportive colleagues
      Preliminary results encouraging
      Volume increasing
      Prometheus stole the secret of fire and gave it to man