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For the first time in Serbia, a single operation for a liver tumor was performed on a five-month-old baby at the Tirsova University Children’s Clinic. The girl is feeling fine, and the surgical team led by Professor Dr. Aleksandar Sretenović, from this clinic, and Professor Dr. Srdjan Nikolić, from the Serbian Institute of Oncology and Radiology, have entered the medical annals since 2014, when went into operation for the first time. technique applied to children, so far in the world performed only a few times.
In a conversation with “Politika”, Dr. Sretenović points out that the operation is called ALPPS and that it allows the surgical treatment of patients with large liver tumors or multiple liver metastases that previously could not be operated on.
– Our little patient is only five months old. His tumor was discovered when he was two months old. It is a huge tumor mass that has affected most of the liver. After being diagnosed with a rare form of malignant liver tumor, the so-called rhabdoid tumor, the baby received six cycles of chemotherapy according to the protocol. Although the size of the tumor was reduced by half after completing chemotherapy, it was still quite large, covering almost six of the eight segments of the liver, making its complete removal in a surgical act impossible and unsafe for the patient. We definitely made the decision to perform the ALPPS procedure the same day as the operation, says Dr. Sretenović, a pediatrician and subspecialist in vascular surgery.
(Personal photo archive)
Surgical treatment of liver tumors involves, whenever possible, the complete removal of the tumor while preserving the remaining healthy liver tissue, which should be of sufficient size for normal function and the life of the patient. However, in large and extensive tumor masses or in cases of multiple liver tumors, it is sometimes impossible to preserve a sufficient amount of residual healthy liver tissue after liver resection and tumor removal, and these patients die after surgery due to to acute liver failure.
– The innovative surgical procedure that we apply provides an opportunity to overcome this problem, taking into account the great regenerative capacity of the liver. The operation is carried out in two acts. Preoperatively, a CT examination (scan) of the liver is performed and, with the help of a special program, the volume of the liver that will remain after its resection and removal of the tumor is calculated. The volume percentage of the future remaining segment of the liver less than 35-40 percent of the total volume of the liver is insufficient for its normal function and the life of the patient, explains our interlocutor.
In the first act, the liver tissue is cut at the edge of the tumorous and healthy part of this organ, and the liver is practically divided into two parts, the smallest healthy and the largest of the affected tumor. After that, the main functional blood vessel is connected, which carries about 75% of the blood to the liver, that is, its branch for the flap affected by the tumor, while maintaining full vascularization for a healthy flap. In this way, all the blood flow that reaches the liver is redirected to a healthy lobe, which, thanks to this, as well as the extraordinary regenerative capacity of the liver, will increase to a volume that will be sufficient for the life of the patient.
– Seven to ten days after the first operation, a control examination is performed with a scanner and the volume of a healthy flap is recalculated. If successful, another operation is performed and the part of the liver affected by the tumor is completely removed. This new surgical procedure, first performed in 2011 and published a year later, was performed in an adult patient with colorectal cancer metastasis to the liver. This operation was performed on the child for the first time in 2014. This is the first time this type of surgery has been performed on a child in Serbia and at the same time, our little patient is the youngest in the world when the procedure was performed. ALPPS – explains Dr. Sretenović.
The doctors at this clinic will continue to apply this intervention to children who need this operation. Previously, babies with large liver tumors required a liver transplant.
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