Dr. Konstantinidis MD, PhD, FACS - General Surgeon & Director of Bariatric, Laparoscopic & Robotic Surgery of Athens Medical Center.
Liver cancer is a type of malignancy that is difficult to treat, for which the earlier the diagnosis the more favorable the chances for the restoration of the patient’s health.
Having the experience of hundreds of surgeries in the liver, Dr. Konstantinidis and his Surgical Team are pioneers in the treatment of liver cancer, being the only ones in Greece that offer the possibility of surgical treatment with the assistance of the state-of-the-art robotic system, da Vinci Xi, at Athens Medical Center.
Thanks to the advanced capabilities of this system, the removal of cancerous tumors is carried out with absolute precision, with excellent oncological outcomes and minimizing the risk of complications.
What is Liver Cancer?
Liver cancer forms in the cells of the liver. Hepatocellular carcinoma is the most common type of liver cancer and occurs most often in people over the age of 65.
When cancer starts in the liver, it is called primary cancer. Liver cancer is often secondary, that is it appears as a metastasis of malignancies that have appeared in other parts of the body, such as the large intestine or the lungs.
What are the symptoms of Liver Cancer?
In its early stages, liver cancer is usually asymptomatic. However, when the first symptoms appear these may include the following:
- loss of weight and appetite
- nausea and vomiting
- swelling and pain in the abdomen
What are the risk factors for Liver Cancer?
The chances of developing primary liver cancer increase with the following risk factors:
- chronic infection with hepatitis B virus or hepatitis C virus
- cirrhosis of the liver
- fatty liver disease
- exposure to aflatoxins, poisons that sometimes contaminate crops such as cereals and nuts
- excessive alcohol consumption
How is liver cancer diagnosed?
The diagnosis of liver cancer includes the following:
- a detailed clinical examination by the doctor
- blood tests, to detect a possible increase in the cancer marker
- ultrasound, to assess the composition of the liver.
- computed tomography (CT) or magnetic resonance imaging (MRI), to give a more accurate picture of the liver and to detect possible smaller nodules.
- histopathological examination (biopsy), which is performed on a sample of liver tissue in special cases
A second histological examination is performed on the tumor and lymph nodes that are surgically removed to determine the type of the cancer.
How is Liver Cancer Staged?
The extent of the disease and the prognosis for each patient are measured in stages. Depending on the stage of the disease, the appropriate treatment is determined.
The stage is determined (staging) through various tests that are performed to reveal the extent of the cancer and whether it has spread to the rest of the body.
If the cancer is suspected to have metastasized, then further tests are carried out on other organs besides the liver, such as chest CT scan and bone scintigraphy, PET, etc.
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How is Liver Cancer treated?
The treatment of liver cancer depends on many factors, such as the type and extent of the disease, whether the cancer is metastatic or not, and the general state of health of the patient.
Depending on the case, the treatment plan may include several therapeutic approaches, such as:
- radiation therapy
- transdermal catalysis with radio frequencies (RF) or microwaves (MW)
- radioembolization / chemoembolization
However, the first line of treatment for liver cancer is surgical removal of the tumor, which also involves a part of the organ (hepatectomy).
Hepatectomy can be performed with open surgery, laparoscopically or robotically.
This is a rather complicated and difficult type of surgery that requires high precision movements, excellent knowledge of the anatomy of the area and extensive experience on behalf of the surgeons.
Dr. Konstantinidis and his Surgical Team constitute a reference point for Greece in the treatment of liver cancer, having performed a great number of robotic hepatectomy operations with excellent results.
What is Laparoscopic Hepatectomy?
In cases that the location and the size of the tumor allow, the removal of the latter can be performed with minimally invasive methods of laparoscopic surgery, which do not involve large incisions, as is the case in open surgery.
Laparoscopic hepatectomy offers many benefits for the patient, such as:
- minimal damage to healthy tissues
- less postoperative pain
- shorter hospital stay
- faster recovery and return to everyday activities
- excellent oncological outcomes
- optimal cosmetic outcomes
What is Robotic Hepatectomy?
Robotic surgery is the evolution of laparoscopic surgery and offers unique benefits in the treatment of liver cancer.
Ideally the removal of the cancerous tumor should be carried out with the least possible injury to the neighboring tissues and removal of parts of the liver.
This is best achieved, when it is oncologically possible, with the assistance of the Da Vinci Xi, the state-of-the-art robotic system Dr. Konstantinidis and his Surgical Team operate with at Athens Medical Center.
A successful robotic hepatectomy always starts with a detailed mapping of the area using special radiological tests, which allow for 3D image reconstruction.
These tests are part of a preoperative study, which determines whether the patient will have oncological benefit and -if operated- sufficient liver balance.
Then, the 3D model results of the radiological tests are integrated into the robot’s computer, allowing the surgeons to superimpose the CT image on the natural image of the patient’s organs.
Thanks to that along with the unparalleled stability of the movements of the robotic arms, an absolute level of accuracy in the surgical incisions is achieved, minimizing the risk of complications that are common in open surgery.
What are the advantages of Robotic Hepatectomy?
The use of the Da Vinci Xi robotic system offers surgeons greater accuracy, stability and control as well as better visibility and access to the surgical field, compared to traditional laparoscopy.
The ergonomic design of the da Vinci Xi robotic system allows surgeons to operate from a comfortable position, sitting in front of a console and enjoying significant benefits such as:
- optimal accuracy and stability of movements
- unparalleled range of motion
- optimal eye contact thanks to the ability to enlarge the surgical field
- increased access to areas not accessible with open or standard laparoscopic surgery
- All the advantages of traditional laparoscopic hepatectomy, such as less postoperative pain, faster recovery and return to daily activities
- minimal risk of complications
One of the most important advantages of robotic hepatectomy is the minimization of complications risk that can be quite serious in such a complex type of surgery.
The robotic tools are small and can be inserted into slits and positions that are impossible to do in open and laparoscopic surgery, which are performed with larger tools.
The robot ensures that no more damage is caused to the liver than what has already been done by the cancer.
In this way, the least possible injury to healthy tissues is ensured and, accordingly, the risk of potential complications -such bleeding or liver failure – from the operation is minimized.
In addition, the patient stands up and walks more quickly, a condition that minimizes the risk of leg thrombosis and lung infections, and the likelihood of adhesions in the organs and hernias after surgery is significantly lower.
What happens after Robotic Hepatectomy?
Robotic hepatectomy is a minimally invasive method and as such allows the patient to walk the same of the surgery or the following day.
However, hospitalization can last several days, as postoperative follow-up is necessary.
Patients remain in the hospital until potential delayed complications are ruled out and liver function is normal.
Depending on the severity of the surgery, hospitalization can range from 2-3 days up to 7-10 days.
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Why Dr. Konstantinidis?
Dr. Konstantinidis and his Surgical Team constitute a reference point in Greece for the treatment of liver cancer, being the only ones who perform Robotic Surgery.
Robotic hepatectomy offers unique benefits in the treatment of liver cancer by dramatically reducing the risk of postoperative complications.
Dr. Konstantinidis and his Surgical Team collaborate with leading specialists in all relevant medical specialties, such as Radiologists, Hepatologists, etc., to design a treatment plan based on the specificity, needs and goals of each patient.