Liver cancer is the sixth most common cancer and the third leading cause of cancer death worldwide. Hepatocellular carcinoma (HCC) is the most common type of liver cancer in adults and usually occurs in people with chronic (long-term) liver disease caused by hepatitis C virus or cirrhosis
Pancreatic cancer is one of the most aggressive tumors of the digestive tract. The most common type of pancreatic cancer, adenocarcinoma of the pancreas, arises when exocrine cells in the pancreas begin to grow out of control.
Surgical treatments
Liver resection is a surgery in which part of the liver is removed. This operation is mainly performed to treat certain types of primary liver tumors and some cases of metastatic cancer of various origins, mainly of colorectal origin
Pancreatectomy is a surgical procedure in which part or all of the pancreas is removed. This surgery is performed in cases of pancreatic tumors, chronic pancreatitis, cysts, or traumatic injuries, among other conditions.
Both types of surgeries are performed by our team in a minimally invasive way, by means of a laparoscopic or robotic approach.
Other treatments
Percutaneous ablation is a minimally invasive procedure that uses imaging technology to guide the precise placement of one or more needles in the center of the tumor to be treated. These needles, using different technologies, apply energy to destroy a volume of tissue in a controlled manner, thus eliminating the tumor. Ablation can be curative in some cases and has a high level of scientific evidence.
Percutaneous ablation can be used to treat a wide variety of tumors in different organs, including: liver, lung, kidney, pancreas, bone, soft tissue, and thyroid.
Surgery after response to systemic treatments
Hepatic sequential surgery is a surgical approach used in the treatment of liver tumors, particularly in cases of liver metastases derived from colorectal cancer. This type of surgery is performed in two stages or sequences, allowing complete resection of the liver tumor in patients who would otherwise not be candidates for surgery due to the extent of the disease.
First stage. A first surgery is performed in which a part of the liver affected by the tumor is resected. In addition, in some cases, hypertrophy of the remaining liver (the part of the liver that remains) can be induced by techniques such as ligation or embolization of the portal vein. This allows the unaffected part of the liver to grow and increase in volume, preparing it for the second stage.
Second stage. After a recovery period, which may last for weeks, a second surgery is performed to resect the part of the liver that initially could not be removed due to the lack of sufficient volume of the remaining liver. At this point, the liver that grew after the first surgery is capable of maintaining the patient's liver functions.
Other treatments
Most normal liver cells are fed by the portal vein, while cancer in the liver is fed mainly by the hepatic artery. Blocking the part of the hepatic artery that feeds the tumor helps kill the cancer cells, but leaves most of the healthy liver cells unaffected because they get their blood supply from the portal vein.
Irreversible electroporation or IRE is a non-thermal tumor ablation technique based on the application of high voltage electrical pulses between pairs of needles inserted around a tumor. The current generated promotes the creation of nanopores in the plasma membrane, triggering apoptosis.
Therefore, IRE can be safely used in locations close to delicate vascular structures, which are contraindicated for other thermoablative techniques.
IRE is currently used successfully for the ablation of tumors in the pancreas, kidney and liver and, very widely, as a focal therapeutic option for prostate cancer.
Chemoembolization, also known as transarterial chemoembolization (TACE), is a procedure that combines the administration of chemotherapy with embolization to treat tumors, primarily in the liver and liver metastases. Chemoembolization focuses a large dose of chemotherapy directly into a tumor, which reduces the blood supply to the tumor, causing it to shrink.
In liver cancer, systemic chemotherapy is an option when the tumor cannot be treated with surgery, has not responded to local therapies such as ablation or embolization, or when targeted therapy is no longer helpful.
In pancreatic cancer, chemotherapy is often part of the treatment for pancreatic cancer and can be used at any stage:
• Before surgery (neoadjuvant chemotherapy).
• After surgery (adjuvant chemotherapy).
• For advanced pancreatic cancer.
Targeted therapy is an advanced option for the treatment of liver and pancreatic cancer.
Liver cancer· Tyrosine Kinase Inhibitors (TKIs). They block specific proteins called kinases, which are crucial for the growth and proliferation of cancer cells.
· Angiogenesis Inhibitors. They prevent the formation of new blood vessels that tumors need to grow.
· EGFR inhibitors. They attack the epidermal growth factor receptor (EGFR), a protein that helps cancer cells grow.
· PARP inhibitors. They block the PARP enzyme, which is important for DNA repair in cancer cells, especially those with mutations in BRCA genes.
Immunotherapy is a promising option for the treatment of liver and pancreatic cancer, as it uses the body's immune system to fight cancer cells.
• Immune Checkpoint Inhibitors. These drugs block specific proteins (such as PD-1 and PD-L1) that cancer cells use to evade the immune system1. By blocking these proteins, the immune response against cancer cells is boosted.
Robotic surgery is an advanced technique that is increasingly used in the treatment of liver and pancreatic cancer.
Robotic surgery allows resections to be performed with greater precision and control. Using the Da Vinci system, surgeons can operate through small incisions, which reduces bleeding, postoperative pain and speeds recovery. This technique is especially useful for localized tumors in areas that are difficult to reach with conventional surgery.
The aim of palliative care is to alleviate the symptoms of the disease and to treat, as best as possible, the side effects of treatments so that patients can live with quality of life.
Liver and pancreatic cancer are extremely aggressive diseases that require specialized and multidisciplinary treatment. At IVOQA, we have a team of surgeons who are experts in surgical oncology and organ transplantation, prepared to tackle these complex pathologies with the most advanced techniques.
