Managing mega tumors of liver – Experience from an emerging HBP unit of a developing country

Abstract

Background/aims: The aim of this study was to review our management for mega liver tumors, greater than or equal to 10 cm in size. Methods: Records of patients referred for evaluation of mega liver tumors on radiological investigation (≥ 10cm) between October 2014 and December 2017 were retrospectively analyzed. Results: Median age was 38.5 years. Five patients (62.5%) were male. Most of the lesions (62.5%) were involving right lobe of the liver along with extension in segment IV. Mean tumor size was 15.5 cm (SD ± 4.6). Hepatoblastoma (25%), primary neurodendocrine tumor of liver (25%) and secondary liver tumors ((25% - adrenocortical tumors with liver invasion) were the most commonly observed pathology, followed by hemangioma (12.5%) and colorectal liver metastasis (12.5%). Preoperative chemotherapy was offered to patients with hepatoblastoma. Right portal vein embolization along with segment IV branches was performed preoperatively in one patient with neuroendocrine tumor. Tri-sectionectomy was performed in four patients. Hemi-hepatectomy, ALPPS and non-anatomical liver resection (for hemangioma) were performed in rest of the patients. Mean duration for intraoperative pringle maneuver was 37.5±19 minutes. Median intraoperative blood loss was 525 mls (287-1775mls). Our mean duration of surgery was 325±127 minutes. Over all hospital stay was 10.3±6.5 days, including ICU stay of 2.5±1.6 days. Only two patients developed postoperative morbidity. Conclusion: In conclusion surgery for mega tumors of liver is challenging. However adequate planning with preoperative portal vein embolization or staged procedure can lead to resection of these large liver tumors safely and successfully.