Pioneering liver surgery for CRLM

Despite a significant reduction in deaths from bowel cancer over the past 40 years, it remains the third most common cancer and second most common cause of cancer death in the UK according to Cancer Research UK. Of the 38,000 new patients affected by colorectal cancer each year, more than half will either present with, or develop, secondary liver metastases during the course of their disease. Liver resection remains the only potentially curative treatment for colorectal liver metastases (CRLM), aiming to remove all macroscopic disease with clear (negative) resection margins and leave sufficient functioning liver. However, liver surgery is technically demanding and has been associated with a number of serious complications. The work undertaken at the Basingstoke and North Hampshire Hospital liver surgery unit, led by consultant hepatobiliary surgeon Mr Myrddin Rees supported by the Pelican Cancer Foundation, has been instrumental in driving several positive changes in national and international practice. The Foundation, which focuses on advancing the most effective techniques in precision surgery for bowel, liver and urological cancer works closely with the liver surgery unit to improve the survival and quality of life of patients. Indeed, in 2010, the 2,000th liver resection performed at the hospital was marked with a gathering including many of the hospital’s cancer survivors.

Bloodless liver surgery

“Although liver resection for metastatic cancer has been reported for over 60 years, as recently as the 1980’s the surgical challenges posed by the liver were regarded by many as insurmountable. Historically, bleeding during liver surgery earned it the reputation of resembling a bloodbath”, said Mr Rees, a trustee of the Pelican Cancer Foundation and past- president of the Association of Upper Gastrointestinal Surgeons (AUGIS). On hearing a lecture given by Professor Johannes Scheele on liver surgery for secondary cancer in the US in the 1980’s, Mr Rees went to study Prof. Scheele’s techniques at the University of Erlangen in Germany. Prof. Scheele then came to Basingstoke to help Mr Rees start the Basingstoke liver resection programme. The unit has since expanded, with the arrival of Mr Tim John in 1998 and Miss Fenella Welsh in 2005. However, of those patients presenting with CRLM, only a small percentage were suitable for resection. The next challenge, therefore, was to increase the number of patients who could undergo this surgery.