At the majority of cancer centers, patients with liver cancer who are candidates for a major liver resection surgery will be given no options other than traditional open surgery. The experts at Miami Cancer Institute, part of Baptist Health, however, will often perform a minimally invasive approach such as laparoscopic or robotic-assisted surgery when surgery for liver cancer is recommended.
Primary liver cancer and intrahepatic bile duct cancer will be diagnosed in more than 41,000 people in the U.S. this year, according to the American Cancer Society. It’s a disease that has tripled in incidence since 1980 and is a leading cause of cancer death worldwide.
When compared with traditional, open procedures, minimally invasive surgeries have numerous advantages for patients. These include smaller incisions, less blood loss, a reduced risk of infection, less pain and a shorter hospital stay. Because of these demonstrated benefits, it’s important that physicians continue to learn the most sophisticated minimally invasive techniques even though they can be quite difficult to master, say doctors at the Institute.
Domenech Asbun, M.D.
“Minimally invasive techniques for liver resection have been slow to be adopted because these are very complex procedures,” explained Domenech Asbun, M.D., a hepatobiliary and pancreatic surgeon at Miami Cancer Institute. “You are operating very close to major blood vessels and many surgeons don’t feel comfortable using instruments that they feel limit their dexterity. While it can be difficult to learn, the equipment does allow for meticulous dissection.”
Dr. Asbun is part of the liver and pancreas surgical team at Miami Cancer Institute that includes his partner, Ramon Jimenez, M.D., and his father, Horacio Asbun, M.D., chief of Hepatobiliary and Pancreatic Surgery and a founding member of the International Laparoscopic Liver Society.
While there have been many advances in radiation therapies and ablation to treat liver cancer - and they are offered at the Institute as well, particularly for patients who cannot undergo surgery - the best way to cure liver cancer is surgery or a liver transplant.
“We bring our cases to our multidisciplinary tumor board to determine the best course of treatment for the individual,” Dr. Asbun said. “Even if a patient has had another treatment, such as chemotherapy, that doesn’t preclude them from getting a minimally invasive procedure later.” The tumor board includes surgeons, medical oncologists, radiation oncologists, pathologists, radiologists, genetic counselors, medical geneticists, social workers, patient navigators and clinical trials staff.
The team was instrumental in the creation of the first international evidence-based guidelines on minimally invasive pancreas resection surgery, now known as the Miami Guidelines, and is again collaborating with surgeons around the world to lead the development of similar guidelines for minimally invasive liver procedures.
Miami Cancer Institute offers an HPB Fellowship program that includes training in advanced minimally invasive hepatobiliary and pancreatic surgery. For more information, click here.
