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  • 1. Introducing Liver Surgery to a Regional Hospital
    Port Macquarie Critical Care Conference
    Dr George Petrou FRACS
    Specialist Surgeon Port Macquarie Base Hospital
    www.portlapsurgery.com.au
    69 Lake Rd, Port Macquarie NSW
    Hepatobiliary Surgery, Laparoscopic Surgery, Obesity Surgery, Endosurgery
  • 2. Is there a need?
    Is it safe?
    Local expertise?
    Preliminary results?
  • 3. Indications for liver surgery
    Colorectal metastases
    Hepatocellular carcinoma
    Cholangiocarcinoma
    Neuroendocrine tumours
    Hepatic sarcomas
    Some benign lesions
    Select metastases- breast, gastric, pancreatic, melanoma
  • 4. 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
  • 5.
  • 6. 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
  • 7.
  • 8. Selecting patients for liver surgery
    30% normal functioning liver remnant
    Patients eligible for surgery – 40-50%
  • 9. Morbidity
    Morbidity 20-30%
    Bleeding 1-3%
    Bile leaks 10-30%
    Infection 10-30%
    Liver failure < 5%
    Wound problems 20%
    PE DVT 1-3%
  • 10. 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
  • 11.
  • 12. Local Expertise
  • 13. 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
  • 14. Feb 2008-Oct 2009
    21 Major 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
  • 15. 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