Challenging case 4kg tumour fibrolamellar HCC, 12-hr surgery

Approximately two months ago Dr. Prof. Tom Cherian, Head of the Liver Transplant team at CARE Hospital, had an unusual patient from Nigeria. A young man of just 19, presented with a tumour that on CT scanning was found to be approximately 4000 ml in volume and 21 cms in size, positioned right in the centre of his liver. The radiological diagnosis was a potential hepatocellular cancer (HCC), which has a poor response to chemo or radiotherapy. The only hope of a cure was with surgery although a small risk of disease recurrence existed.

Speaking on the unique situation Prof. Dr. Tom Cherian said, “At first look it appeared an impossible task. The tumour involved almost 6 out of 8 lobes of the liver and was running very close to all the crucial vessels supplying blood to this vital organ. Moreover there was obstruction to the flow of bile due to the tumour, resulting in high bilirubin levels (Jaundice). However given the age of the patient and the fact that without surgery his life was limited to a few months, I felt we had to try. The family was warned about the risks and with a deep faith in God we went ahead.”


Prior to the procedure, meticulous planning was carried out with careful assessment of the patient and the residual liver. The complex procedure took over 12 hours and involved nearly 20 medical professionals. As there was a satellite tumour, after the main surgery, a secondary procedure called radio frequency ablation was carried out to kill the remaining cancer cells.

Prof.Tom Cherian said, “The final histology confirmed the cancer to be a fibrolamellar HCC which has a relatively good prognosis (long-term outcome). Although the post-operative course was stormy, I am glad he has recovered well and is now getting discharged. The dedication and hard work put in by the CARE team every time we perform something this complex, continues to fill me with great pride.” Prof. Cherian has performed over 500 Liver Transplants during his career of which 17 years was in England. Last year he performed the first ever government sector liver transplant in Osmania Hospital, Hyderabad. Dr. Raghav Raju, Medical Director & Dr. Biswaroop Pal, the Liver Critical Care expert said, “Our liver unit has a large team of specialists, comprised of Hepatologists, Liver transplant surgeons, Critical Care Specialists and Anesthetists, who are supported by a strong commitment to deliver exceptional patient care. It is this ability, that allowed us to carry out these feats successfully.”

CARE HOSPITALS, owned by Quality Care India Ltd, is one of the fastest growing chains of hospitals in India, managed by dedicated professionals, engaged in providing primary as well as tertiary healthcare services. Founded in1997 by Padmashri Dr. B. Soma Raju and a team of leading cardiologists, CARE Hospitals is today the fourth largest chain of hospitals in the country with a pan India presence (15 hospitals serving 7 cities in 7 states in India). It commenced robotic surgery for the first time in South India.


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