Hepatectomy delivers for a special patient
The close collaboration and caring attitude of a Macquarie University Hospital team made possible a variety of options in treating a large liver tumour – and turned a patient’s attitude around.
With no former liver disease and in general good health, Guiseppe (Jo) Conciatore and his family were shocked when he was diagnosed with a large liver tumour at the age of 76. An ultrasound and CT scan, early in 2013, confirmed an hepatocellular carcinoma (HCC) of about 10 centimetres in diameter, and in need of immediate treatment.
Initially daunted by the public health care system and resistant to treatment, Jo and his family finally went to see Dr Pirooz Poursoltan, a medical oncologist at Macquarie University Hospital. This, said his daughter Maria, was the turning point in Jo’s attitude towards his health and treatment.
“Up to this point, dad had been in total denial about what was clearly a very large tumour and the need for intervention,” said Maria. “He was daunted by what he experienced as the large and impersonal nature of the public system. And he was very uncomfortable venturing far from the family home in Ryde.
“Dr Poursoltan treated dad kindly, taking the time to explain the implications of the tumour and putting more treatment options to us than we were aware of before. He did much of this by drawing simple diagrams so that we could properly understand what he meant. Based on this, Dad finally started to accept that he had a large tumour and that something needed to be done. As a family, we were so relieved.”
Working through Macquarie Medical Imaging, Dr Poursoltan aimed to reduce the size of the tumour, pre-operatively, by way of transarterial chemoembolisation, or TACE, treatment – involving a catheter fed through a small groin incision to the tumour and carrying a chemotherapy agent.
After three treatments, necrosis to large parts of the liver tumour was evident, with the tumour also having shrunk to about 8cm. This outcome made Jo a better candidate for surgery.
In August, Jo and his family met with Dr Sameer Mihrshahi, upper gastrointestinal surgeon at Macquarie University Hospital, who first performed a laparoscopic biopsy of the healthy part of Jo’s liver to make sure it was free from any liver disease. The pathology report showed a clean result.
Then, in September, Dr Mihrshahi performed a large open surgical procedure – an extended right hepatectomy – to remove the right and some of the left-hand side of the liver. In all, about three-quarters of the liver was removed. Again, post-operative pathology results were good.
“Because of the hospital’s location, the family were able to visit dad several times a day,” said Maria. “I know this contributed immensely to his recovery. Dad’s doctors visited him regularly and, again, took lots of time to talk to him and the family about the treatment, recovery and the long-term monitoring of his health.
“I think that the personalised service from Macquarie University Hospital is, in a sense, what saved dad’s life because until we went there, Dad had refused any treatment.”
Jo’s liver has regrown, in line with what doctors expected, and Jo has had one follow-up localised radiotherapy treatment – administered through the artery – that is designed to target any microscopic cells remaining. This will be followed by regular monitoring with CT scans and blood tests for the next few years. His doctors say that he is doing remarkably well.