3 important reasons why you should consult a transplant surgeon for liver cancer

#1 Transplantation is one of the curative treatments for liver cancer.

Liver transplantation is one of important curative treatments in liver cancer. Liver transplantation for hepatocellular carcinoma is an established treatment and non-transplant liver surgeon do not always exercise this option. Transplantation offers a more complete package for the patient and allows treatment of underlying liver disease in addition to the liver cancer. While liver resection is simple oncologic surgery, development and running a transplant team requires better understanding of systems and patient care and transplant teams excel in complex patient care. In fact, transplant surgeons and teams treat complex HCC with transplant more easily than any of the other indications for liver transplantation.

Consulting a liver transplant team is the best advice one can offer before you are treated for liver cancer. The indications for liver transplant in HCC is expanding and we currently follow the established UCSF criteria for transplantation and use specific tests when patients want to exercise the transplant option using living donors to see how much survival can be expected in the given patient.

Whatever the final decision may be, consulting a transplant team will remain one of the best advises for the treatment of liver cancer.

#2 They are more comfortable in resecting involved blood vessels along with the cancer and increasing the chances of a complete resection.

The principal surgical skill of a liver transplant surgeon is ability to work around the major blood vessels of the body and capacity to resect and repair those vessels. In India, this seems to be a very important skill as our patients seem to present with more advanced disease at the time of presentation. 

Liver resections for cancers close to either hepatic veins or portal veins are fraught with danger of major bleeding. Most liver transplant surgeons dissect either structure comfortably and also are well trained to bypass the blood to the whole liver and complete a complicated resection.

Resections like trisectionectomies were developed by transplant teams and are considered very major resections. Most of the non transplant surgeons would avoid such a resection on account of the complexity as well as the intensity of post operative care involved.

There are 2 further resections that are done only by transplant surgeons - in situ hypoperfusion and ex vivo resections. These surgeries are done for patients with cancer involving the hepatic veins that drain the blood out of the liver. It involved complete division of the liver from the vena cava and safe removal of all the cancerous tissue.

# 3 They are more capable of handling post operative liver failure.

Transplant surgeons learn to manage liver dysfunction after liver resection as they are exposed to management of small for size syndrome in living donor liver transplants. Liver dysfunction requires meticulous attention to detail and prevention of any second injury to the patient. Attention to this detail invariably translates into good results for the patient. Better management of portal perfusion, better electrolyte management and better management of other systems of the body allows patient to have a less stormy recovery.

There is one more quality that every transplant surgeon gets at the end of training - it is the ability to never give up trying. This works well for the patient. For the transplant surgeons, it is actually less stressful to do these resections as even the most complex resections are easier than a transplant. For the patient, transplant surgeons provide a wider option for curative treatments, provide better operative skills for complex surgery and better medical care during the recovery phase.