Less invasive surgery works for liver, too

NEW YORK Thu Nov 18, 2010 1:44pm EST

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NEW YORK (Reuters Health) - People who undergo surgery to remove benign or cancerous tumors in their liver appear to fare better when they receive a newer type of surgery that makes only small incisions, two new reports show.

More than 24,000 Americans are expected to get liver cancer in 2010, and nearly 19,000 will die from the disease, according to the National Cancer Institute.

While there are several treatments available, such as radiation and chemotherapy, surgery is a common option.

In the new studies, two research teams tried to gauge how laparoscopy, an increasingly popular type of surgery in which doctors make a few small incisions, compared with traditional surgery, in which they make one long cut to enter the body.

Reviewing earlier published reports, they found patients who underwent laparoscopic surgery had less blood loss, needed less pain medication, and were able leave the hospital earlier.

One of the research teams, based in Canada, also found that people receiving laparoscopic surgery had a 60 percent lower chance of complications after surgery. And those with cancer tumors were 36 percent less likely to have died two to five years after surgery.

The other research team, from the University of Pittsburgh in Pennsylvania, found no differences in survival after the two types of surgery. Both teams were limited in their conclusions, however, because none of the studies they reviewed was optimally designed, with patients randomly assigned to each surgery.

Doctors now use laparoscopy during surgery in many organs -- including the gall bladder, spleen and colon -- and this research should help add another organ to that list, said Dr. Joseph Buell of Tulane University, who was not involved in the studies.

"This is something that benefits patients, and it works," Buell told Reuters Health. "I think that people should have an option."

The reason laparoscopic liver surgery likely benefits patients, said Dr. David Geller, who led the University of Pittsburgh team, is that it's less invasive than the traditional technique.

Many surgeons continue to rely on larger incisions that enable them to visualize the liver directly, but that is often because they aren't trained in laparoscopy, Geller told Reuters Health.

There have also been concerns that doctors who use smaller incisions may inadvertently spill cancer cells as they pull tumors out of the tiny opening. But there was "not a single report" of this occurring, Geller said.

According to Buell, doctors have also reasoned that controlling an accidental bleed would be easier with a larger incision, where "everything is right in front of you."

However, these reports, based on published results as well as new data from almost 1,300 patients at the University of Pittsburgh Medical Center, showed there was less blood loss with the newer technique, not more.

Both studies appear in the November issue of the Archives of Surgery.

Although laparoscopy costs more in the operating room, patients who received it spent two to three days less recovering in the hospital, Geller and colleagues found.

Recently, the team reported that hospital costs for laparoscopy totaled $15,000 on average, versus $18,000 for the traditional technique. During laparoscopy, doctors make a few incisions between one-quarter and one-half inch in size, whereas the incision in traditional surgery is several inches long.

Still, laparoscopy is not an option for everybody. People with multiple liver tumors, for instance, or tumors that are too large or too close to blood vessels will need a large incision, Geller noted.

Buell said he travels the world teaching doctors to use the laparoscope -- a telescope-like tube inserted through one of the incisions to guide the surgery -- and has himself performed 400 of these procedures.

Patients should seek out experienced surgeons, he cautioned, since it can take 50 or so liver surgeries before most doctors feel comfortable using a laparoscope.

What's encouraging, Geller noted, is that people with liver cancer now have one more tool at their disposal.

"When people and their loved ones are diagnosed with liver cancer, in the old days that would be a death sentence," he said. "There's hope, and there are treatment options for liver cancer."

SOURCE: link.reuters.com/zuk26q and link.reuters.com/xuk26q Archives of Surgery, November 15, 2010.

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