OPINION Everything on this page was said in a consultation or call, not written in a signed document; it is the doctor's view, not an established fact. How to read the tags
Bottom line
Two-stage liver resection is on the table, and it is the only route discussed that could be radical. Step 1: right hemihepatectomy (takes the 15 × 10 cm mass and the segment I lesion). Step 2, after the left lobe regenerates: removal of the segment II/III focus, or the whole segment III. Not in one stage — risk of liver failure. First action: new PET-CT; if stable, proceed.
Left-lobe focus
- Sits between the left hepatic vein and the segment III branches, wrapping the vessels. Open question: how deeply it invades them.
- Superficial invasion → resectable with a margin; all liver metastases could then be removed surgically.
- Deep invasion found during stage 2 → more liver has to go than planned → liver-failure risk. This is why it is never done in one stage.
- Options for stage 2: targeted removal leaving a cavity in the parenchyma (technically feasible, not simple), or resection of the whole segment III.
- The decision is made after stage 1 plus a repeat CT, once the left lobe has regenerated — clearer then, though not 100 %.
- What the radiologist called a left-lobe lesion is in fact segment I; it can be removed during the first resection.
Palliative resection (debulking)
- Acceptable on its own: "we remove the tumour load — that is treatment too". Described as effective for GIST, though not radical.
- The right-lobe mass comes out with the right lobe.
- Caveat he raised himself: a two-stage operation with risks at both stages is justified mainly if the goal is radical resection. For debulking alone, he questions whether oncologists would endorse it — the case must pass a multidisciplinary tumour board, with an argument for the patient's benefit.
Stomach (primary tumour)
- Metabolically controlled. Technically easy to remove.
- Could be taken out during the same palliative operation, but he would rather not: tissue healing after extensive resections is worse, with anastomotic-leak risk.
Before any major resection
- PET-CT first. If the picture is stable and there are no contraindications, continue with the plan.
- Staging laparoscopy — his recommendation: rule out peritoneal nodules that "MRI and CT do not see". Non-traumatic, inspection of the abdominal cavity, biopsy if anything is found.
- Order: basic workup first (ultrasound, echocardiography and so on), then laparoscopy as a staging step. Basic tests can be done quickly.
- Bones: suspicious foci were described earlier — needs imaging and a specialist opinion on all extrahepatic foci before committing.
Sceptical about
- Embolisation — works on hypervascular tumours; hers is hypovascular ("dark on CT") → limited.
- Radioembolisation / radiointerventional treatment — not targeted enough given the volume: resorption of a large amount of tumour parenchyma, which can turn into an abscess.
- Histotripsy and "apoptosis of tumour cells only" — "that does not work".
- Electrochemotherapy (as offered in Ukraine) — electrodes too short, not for the liver.
Consultation fee. He declined at first ("not necessary") and agreed to send details only when pressed.