A MINIMALLY invasive surgical technique, combined with immunotherapy and targeted radiation therapy, recently enabled successful liver tumour removal in a patient with cirrhosis who was previously ineligible for surgery.
Liver cancer risk is significantly higher in individuals with cirrhosis, a condition where healthy liver tissue is replaced with scar tissue, impairing organ function. Advanced liver cancer in patients with cirrhosis is typically considered untreatable with surgery or transplant due to the high risks involved. However, a new study demonstrated how a combination of immunotherapy, targeted radiation therapy, and a refined surgical approach led to successful tumour removal in a high-risk patient. This study suggests that certain patients previously deemed inoperable may benefit from a more tailored, multidisciplinary treatment strategy.
Researchers utilised a stepwise approach to treatment, beginning with transarterial radioembolisation (TARE), a form of targeted radiation therapy that selectively reduces tumour size while preserving surrounding liver tissue. Immunotherapy was then introduced to enhance the body’s immune response against the cancer, further reducing tumour burden. Once these treatments had rendered the tumour resectable, laparoscopic surgery was performed using the Arantius-first technique. This minimally invasive method uses the Arantius’ ligament as a landmark to quickly identify and preserve the middle hepatic vein, a major blood vessel in the liver. Compared to conventional approaches, this technique reduces the risk of vascular injury, which is particularly crucial in patients with cirrhosis who have a limited functional liver reserve. In this case, the combination of preoperative treatments and precise surgical intervention resulted in successful tumour removal without severe complications.
The findings highlight the potential for expanding surgical options in patients with liver cancer and cirrhosis by integrating advanced therapeutic strategies with refined surgical techniques. While further research is required to validate these outcomes in larger patient groups, this study underscores the importance of a multidisciplinary approach, where surgeons, oncologists, and radiologists collaborate to optimise treatment pathways.
Jenna Lorge, EMJ
Reference
Kawahara W. Laparoscopic left hemihepatectomy using the Arantius-first approach after 90Y transarterial radioembolization and immunotherapy in a cirrhotic patient. BJS. 2025;DOI:10.1093/bjs/znae305.
