Introducing Liver Surgery In Port Macquarie


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Introducing Liver Surgery In Port Macquarie

  1. 1. Introducing Liver Surgery to a Regional Hospital<br />Port Macquarie Critical Care Conference<br />Dr George Petrou FRACS<br />Specialist Surgeon Port Macquarie Base Hospital<br /> 69 Lake Rd, Port Macquarie NSW<br />Hepatobiliary Surgery, Laparoscopic Surgery, Obesity Surgery, Endosurgery<br />
  2. 2. Is there a need?<br />Is it safe?<br />Local expertise?<br />Preliminary results?<br />
  3. 3. Is there a need?<br />
  4. 4. Indications for liver surgery<br />Colorectal metastases<br />Hepatocellular carcinoma<br />Cholangiocarcinoma<br />Neuroendocrine tumours<br />Hepatic sarcomas<br />Some benign lesions<br />Select metastases- breast, gastric, pancreatic, melanoma<br />
  5. 5. Colorectal Cancer<br />2nd most common cancer in Australia<br />2nd cancer killer<br />50% patients with colorectal cancer have or will develop liver metastases<br />15% patients have liver mets at time of diagnoses of primary<br />120 colorectal cancer resections performed in Port Macquarie per year<br />
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  7. 7. Selecting patients<br />Traditional<br />Morbid operation with high risk of bleeding<br />Resectable lesion<br />&lt; 5cm<br />&lt;3 lesions<br />No bilobar disease<br />No extrahepatic disease<br />No synchronous disease<br />Margin &gt; 1cm<br />CEA&lt; 200<br />10% patients with CRC liver mets candidates for surgery<br />
  8. 8. New Chemotherapy<br />FOLFOX- median survival 24 months<br />New agents are pushing this 2 year hurdle successfully<br />FOLFIRI, FOLFOXFIRI<br />+/- VEG inhibitors<br />Now chemo alone med survival &gt; 2 years<br />5 year hurdle is only a matter of time<br />
  9. 9.
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  11. 11. Selecting patients for liver surgery<br />30% normal functioning liver remnant<br />Patients eligible for surgery – 40-50%<br />
  12. 12. Is it safe?<br />
  13. 13. Morbidity<br />Morbidity 20-30%<br />Bleeding 1-3%<br />Bile leaks 10-30%<br />Infection 10-30%<br />Liver failure &lt; 5%<br />Wound problems 20%<br />PE DVT 1-3%<br />
  14. 14. Safe Despite Significant Morbidity<br />Preoperative assessments of liver function<br />Preoperative anaesthetic assessment<br />Modern imaging- CT, MRI, PET<br />Intraoperative ultrasound<br />Post operatve anaesthetic and intensive care expertise<br />Interventional radiology<br />Surgical devices<br />CUSA<br />Staples<br />Ligasure<br />Argon<br />Electrocautery<br />Flowseal<br />
  15. 15.
  16. 16. Local Expertise<br />
  17. 17. Our service in Port Macquarie<br />Established GIT multidisciplinary team (Cancer Care Centre)<br />Easily accessible high definition CT and MRI <br />No PET- send to Sydney<br />Established interventional radiology with experience in percutaneousdrain placement<br />Theatre team with experience in major vascular and GIT surgery<br />Anaesthetic and ICU experience in major vascular and GIT surgery<br />Established GIT medical oncology<br />
  18. 18. Preliminary resultsPort Macquarie Base Hospital<br />
  19. 19. Feb 2008-Sep 2009<br />19 Major liver resection completed<br />4 Minor liver resections completed<br />3 Major liver resections on waiting list<br />CRC 12 (46%)<br />Benign 10 (38.5%)<br />Cholangiocarcinoma (8%)<br />HCC 1 (4%)<br />SI cancer 1 (4%)<br />Median operating time 3 hrs<br />Blood transfusions- 3 units packed cells (total)<br />30 day mortality 1 (4%) Liver failure<br />Post 30 day mortality 1 (4%) Pulmonary embolism<br />Morbidity data and survival data- soon to be published<br />
  20. 20. Summary Introducing Liver Surgery to a Regional Hospital <br />Challenging but exciting time<br />Enthusiastic and supportive colleagues<br />Preliminary results encouraging<br />Volume increasing<br />Prometheus stole the secret of fire and gave it to man<br />