University of Cincinnati, Department of Surgery
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Multidisciplinary Liver Treatment Center

This multidisciplinary program incorporates the disciplines of surgical oncology, transplant surgery, gastrointestinal surgery, interventional radiology, hepatology, advanced therapeutic endoscopy, and radiation oncology. This calls on the combined talents of Drs. Syed Ahmad, Jeffrey Sussman, Steven Rudich, Amit Tevar, Mark Thomas, and E. Steve Woodle within the Department of Surgery and many colleagues in the Departments of Internal Medicine and Radiology.

Utilizing this wide range of expertise brings unique insight into the management of benign and malignant tumors and other disorders of the liver and biliary tree. During the last calendar year the program performed over 300 advanced hepatobiliary surgical procedures, evaluating and treating patients from as far away as Texas, Milwaukee and New Jersey. State-of-the-art surgical techniques available through this program include ex vivo (out of body) and laparoscopic liver surgery.

Among the conditions within the expertise of the program include primary and metastatic liver tumors and benign and malignant obstruction of the bile ducts. The hepatobiliary program has emphasized the management of benign and malignant disease with minimally invasive surgical techniques. This allows patients to undergo major hepatic surgery with very short post-operative stays and much quicker return to normal activities.

The program also prides itself on the ability to manage those advanced malignancies referred out by other major institutions, including large hepatocellular carcinomas (liver cancers), hilar cholangio-carcinomas (bile duct cancers in the middle of the liver) and vena cava tumors (tumors of the major blood vessel).

New technologies have also been introduced and refined at the University of Cincinnati. These include the introduction of radiofrequency ablation of tumors (burning of unresectable cancers) and isolated hepatic perfusions. This is a surgical procedure that allows treatment of unresectable liver cancer with hyperthermic (heated) chemotherapy at superhuman doses. In addition, the Multidisciplinary Live Disease Treatment Center is the first in the region to introduce TheraSpheres to treat both primary and metastatic liver lesions.  TheraSpheres are microscopic glass beads made with a compound that emits high dose radiation energy.

UC Liver Transplant Program

The University of Cincinnati Liver Transplant Program has been revitalized, with more adult liver transplants performed in Cincinnati over a six-month period during the past year than in the other four Ohio liver transplant programs. As a result, many more patients have been removed from the waiting list and returned to a normal life. Both allograft and patient survival have been excellent, exceeding national averages.

Liver transplantation has become the principal means of treating hepatocellular carcinoma in the face of chronic hepatitis infection (either hepatitis B or C).  Over the past decade, the Center’s five-year survival rate has risen dramatically in heptocellular carcinoma patients treated by liver replacement from 35% to 75%.

This increase in transplant activity has occurred largely due to the more aggressive recruitment of local and statewide organ donors through the widespread use of "extended criteria donors." Whereas organ donors with advanced age, certain types of infections, containing high degrees of fat, among other factors, were previously not considered for liver donation, the new approach has enabled the acceptance of these organ donors by minimizing the time the donor is without blood flow as well as manipulating post-transplant immunosuppression drugs.

Minimally Invasive Hepatic Resection

The University of Cincinnati is one of the pioneers in the field of laparoscopic liver surgery, and minimally invasive liver resections.  This procedure allows major lobar resections to be performed through a very small incision, resulting in significantly less pain for patients and early discharge, often after one in-hospital day.

Radiofrequency Ablation

The incidence of cirrhosis in the community is climbing due to the new prevalence of hepatitis C.  Less than 10% of liver tumors have been treatable through traditional resection techniques.  Radiofrequency ablation allows both an open and minimally invasive approach for local tumor destruction.  This treatment modality has been curative in smaller tumors and has often been utilized as a bridge to liver transplantation.  This approach is used in situations where a formal hepatic resection is contraindicated, such as in patients with advanced cirrhosis (wherein any major surgical procedure can be life threatening).

Trans-Arterial Chemo-Embolization (TACE)

TACE is an interventional radiology procedure that allows local hepatic tumor therapy without a surgical approach.  Combining local intrahepatic delivery of chemotherapy with embolization of the tumor’s arterial supply, a synergistic effect occurs which results in higher local drug concentrations and reduced systemic toxicity.

Portal Vein Embolization (PVE)

In cases where standard hepatic resection is deemed high risk due to a lack of remnant normal hepatic tissue, the application of PVE, with our colleagues in Interventional Radiology, allows the remaining liver to grown prior to  major resection.  This approach allows extensive hepatic resections such as right and left trisegmentectomies to be performed safely, helping to eliminate the risk of postoperative hepatic insufficiency.

Research

A fruitful collaboration has been arranged with the Department of Biomedical Engineering, in which novel ultrasound-based technologies will be used to both image and ablate liver tumors simultaneously.  This is being pursued in both a rabbit and swine model.  Plans also include significant collaborations with basic scientists at the University of Cincinnati Genomics Research Institute to study the genomics of liver carcinoma; in particular, to ascertain the role of mTOR (mammalian target of rapamycin) in the promulgation of hepatocellular carcinoma.