New study offers hope to patients with advanced liver cancer, cirrhosis

The risk of developing liver cancer is increased in people who have cirrhosis, a disease in which healthy liver tissue is replaced by scar tissue. The scar tissue blocks the flow of blood through the liver and keeps it from functioning as it should, and patients with advanced liver cancer and cirrhosis are normally considered unsuitable for surgery or transplant.

In a new study published in the British Journal of Surgery, researchers describe successful tumor removal through the use of immunotherapy and targeted radiation therapy (TARE), in a patient previously considered ineligible for the procedure.

“Our study describes how a minimally invasive surgical approach known as the Arantius-first technique, can be applied in high-risk populations, potentially expanding surgical indications for patients with cirrhosis,” explains corresponding author Eduardo Vega, MD, assistant professor of surgery at Boston University Chobanian & Avedisian School of Medicine. The Arantius-first technique is a laparoscopic procedure that uses the Arantius' ligament as an anatomical landmark to quickly expose the middle hepatic vein (MHV).

This method allows the surgeon to quickly and accurately locate the MHV, one of the liver's major vessels. In conventional approaches, there is a higher risk of split injuries or iatrogenic damage to the MHV, which can lead to severe complications, particularly in patients with cirrhosis who have limited functional liver reserve. By focusing on this landmark, the Arantius-first technique minimizes the risk of injuring the MHV and ensures its preservation, which is critical during a left hepatectomy in cirrhotic patients. This precision not only enhances the safety of the procedure but also contributes to better patient outcomes.

This patient’s care involved multiple steps. First, the tumor was treated with TARE, a targeted radiation therapy that reduces tumor size while sparing healthy liver tissue. Next, immunotherapy was used to boost the immune system’s ability to fight the cancer. These combined treatments transformed the tumor from unresectable to resectable. Finally, laparoscopic surgery was performed using the "Arantius-first" technique, which allowed for precise tumor removal while minimizing harm to the remaining liver.

Reference:

William Kawahara, Belen Rivera, Jeffrey Roberts, Cathleen Huang, Aishatu Ladu, George P Sorescu, Dmitry J Rabkin, Olga Kozyreva, Fernando Rotellar, Eduardo A Vega, Laparoscopic left hemihepatectomy using the Arantius-first approach after 90Y transarterial radioembolization and immunotherapy in a cirrhotic patient, British Journal of Surgery, Volume 112, Issue 2, February 2025, znae305, https://doi.org/10.1093/bjs/znae305