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  May 26th,2016

The General Surgery Service at HM Sanchinarro successfully performs three hepatic chemosaturation procedures

Madrid, 17 May 2016. The General and Digestive Surgery at HM Sanchinarro University Hospital, led by Dr. Emilio Vicente and Dr. Yolanda Quijano, has successfully launched its hepatic chemosaturation programme by successfully performing three procedures.

“This is a new approach to treating liver tumours. The liver is isolated from the blood supply and concentrated doses of a chemotherapy drug are delivered directly to the liver, “bathing" the entire organ. The blood draining the liver is filtrated through an extracorporeal system to remove as much of the chemotherapy agent as possible before putting it back in the body through a major vein", explains Dr. Vicente ad Dr. Quijano.

Since the liver is isolated from the rest of the body, the chemotherapeutic drugs can be administered at a higher dosage than those which can be administered through systemic chemotherapy. By administering this drug to the entire liver, the treatment affects both visible tumours and small undetected tumours. The associated side effects are also minimised and more manageable, add the experts.

This process is effective in primary liver tumours, peripheral cholangiocarcinoma, neuroendocrine tumours and colorectal liver metastases.


How is it performed?

Three steps are involved in chemosaturation:

  1. Hepatic isolation: performed by placing a catheter with two balloons in the inferior vena cava. These balloons isolate the liver from the rest of the body.
  2. Saturation of the hepatic artery: administration of a potent cancer drug. The drug is delivered directly to the liver. Balloons prevent the drug from being administered to other parts of the body, making it possible to deliver a dosage that would be impossible if administered systemically. The toxicity associated with the administration of chemotherapeutic drugs is minimised. This saturation is carried out with an extracorporeal circulation system.
  3. Filtration of the liver: after the anti-cancer drug has been administered to the liver, the filter incorporated into the system removes almost all of the drug from the blood. This is important step that helps reduce the drug's side effects post-procedure.


Vascular radiology and anaesthetic technique in liver chemosaturation

Dr. Echanagusia and Dr. Camúñez, interventional vascular radiologists at HM Hospitals, point out that extensive experience in this field is needed to perform this technique. “Different vascular structures (arterial and venous) must be percutaneously channelled first, and then, in the most complex step of the procedure, two occlusion balloons must be inserted in the right places, one in the inferior vena cava above the bifurcation of the hepatic veins and the other above the renal veins", they say. A single error while “anchoring" these balloons makes it possible for the chemotherapeutic drug to spread to the circulatory system.

The anaesthetic technique is also paramount in this surgery. “There are serious hemodynamic changes that are produced during chemosaturation that require anaesthetic strict control during the procedure", asserts Dr. Román, Dr. Corbacho and Dr. Martín from HM Sanchinarro's Anaesthesiology Service.

The successful percutaneously completion of the procedure in recent years has been a breakthrough, significantly reducing the technique's morbidity rate.

Very few hospitals in the world perform this technique, with only around 300 of these surgeries having been performed in Europe. This is the second series in Spain and there are only two Spanish hospitals where this technique is performed.

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