The doctors from institute of liver diseases, transplant and surgery MGM Healthcare, a multi-specialty quaternary care hospital, Chennai , today announced the successful outcome of a complex innovative multimodal procedure for multiple Synchronous Liver Metastases in a Stage 4 Colorectal Cancer patient. As per the hospital, probably it is the first time in the country that such complex stage 4 colorectal cancer was operated in a single sitting.
Mrs. Madhavi Muralidharan, a 60-year-old lady from Chennai was diagnosed with stage 4 cancer junction of colon and rectum (large intestine) with multiple metastatic spread in liver (9 lesions in different areas occupying most of the liver). She also experienced weight loss and loss of appetite further hampering her physical movements. She travelled to different cancer hospitals and was informed that her disease is not curable and had only few months of life left. Her family was then advised to consult with Dr. Thiagarajan Srinivasan, Director, Institute of liver transplant and GI surgery, MGM healthcare, Chennai. Dr. Thiagarajan after a thorough analysis of the case informed the patient and her family that the cancer could be cured with an innovative treatment and she was asked to follow-up with Dr. Arun Ramanan, Medical oncologist for further treatment. The family after consultation with the doctors at MGM Healthcare gave their consent for the complex surgery.
Dr. Thiagarajan elaborated about the case and said, “We decided to go ahead with a single stage surgery for a complex synchronous liver metastasis and the rectal cancer of the patient. We recreated the surgery through 3D volumetry of the lesions and future liver remnant and 3D reconstruction was undertaken by an expert radiologist team. A detailed 3D simulation of surgical removal all the nine liver lesions was virtually undertaken by the team before the surgery because excess removal of liver would have led to liver failure and inadequate removal of lesions will cause recurrence of cancer and reduce the lifespan of the patient.
He further added, “The patient underwent a single stage removal of all nine lesions of liver and removal of cancer of colon and rectum with a diversion stoma. She underwent post-operative biological tumor antibody therapy and cancer chemotherapy for 6 months. We are happy to report that a rigorous follow-up of 8 months the patient is completely cured of the cancer with no detectable tumor in whole of her body which was confirmed by a PETCT scan. Mrs. Madhavi has also managed to gain back her weight and is now able to lead a normal and healthy life after restoration of stoma. We salute the spirit of the patient and her family and thank them for placing their trust in our team. This story gives hope to a lot of patients with advanced colorectal cancer with liver metastasis to live a long life.”
Dr. Thiagarajan added, “Colorectal cancer is the sixth commonest cancer in India, with 5 new cases occurring for every one lakh persons in a year with incidence rising by 20% every decade. Stage-1 colorectal cancer has 90% 5-year survival after multimodal therapy whereas stage-4 colorectal cancer has only 10% 5-year survival rate. The rising cases can be attributed to changing lifestyles that include consumption of calorie-rich and low fibre diet, excessive use of red meat and processed foods, and physical inactivity. Stage 4 Colorectal Cancers with only liver spread are unique in a way that they can be treated with a unique treatment which is a combination of complex and innovative single or staged surgeries, chemotherapy, targeted biological tumor antibody therapy, radiotherapy and in rare cases even liver transplantation. These efforts can result in increase of 5-year survival rate to 60 % which can be the best among all the cancers.
Dr. Karthik Mathivanan, Associate Director said, “Colorectal cancer is the 5th leading cause of cancer death in India as most of the cases are diagnosed in advanced stage. 20-25% of the colorectal cancer patients present with liver metastases. As liver has the capacity to regenerate extensive liver resection up to 70% is possible for multiple liver lesions and to have curative surgery is a feasible option. There is lack of awareness and we recommend routine annual screening for people above 45 years with a colonoscopy that will help us nip it in the bud. It’s unfortunate that only <5% of the adult population are screened annually in the country.”
Dr. Arun Ramanan, Consultant Medical Oncologist added, “Sometimes even though patients who have significant hepatic metastases in both lobes of the liver if and only when cannot be cured with a single operation, curative resection can still be performed in two stages after successfully down staging with chemo and/or targeted therapy. Close coordination in such case among the members of a multi-disciplinary team becomes extremely important as it boosts the chances of survival for such patients. The recent advances in multimodal therapy ( like targeted immunotherapy, biologicals, newer chemotherapy agents sometimes stereotactic radiotherapy(for a patient with a rectal primary) and partitioned and staged liver surgeries with various forms of future remnant liver volume augmentation therapies can go a long way in treating colorectal cancer effectively.
Dr. Harish Manian CEO, MGM Healthcare shared his views and said “The Institute of liver diseases, transplant, GI and HPB surgery at MGM Healthcare is a one-stop destination for all diseases of the liver, pancreas, biliary tree and intestines. The state-of-the-art highly advanced institute has more than 100 highly qualified professionals providing round the clock highest standard of services. Our experienced team of transplant and HPB surgeons, gastroenterologists, hepatologists , critical care specialists, pediatric liver specialists, pediatric liver surgeons , interventional radiologists and gastroenterologists are here to help the patients manage and treat any disease or condition of the gastrointestinal and liver-pancreatic-biliary system.”