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
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
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 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
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