Russian oncologists performed liver chemoperfusion with endovascular access to the tumor for the first time
The unique operation was performed by an interdisciplinary team of oncologists and specialists of related specialties of the NMIC of Radiology of the Ministry of Health of Russia and the Kostroma Regional Oncological Dispensary. Oncologists Unguryan V.M. and Petrov L.O., X-ray endovascular surgeons Kucherov V.V., Petrosyan A.P., Trifonov F.A. and Nadinsky D.O., vascular surgeon Iofik V.V., anesthesiologists Khudyakov P.A., Fokina O.I. and Sytik O.N., perfusiologists Pobedintseva Yu.A. and Filimonov E.V. took part in the operation., chemotherapists Falaleeva N.A. and Mamonova A.O., ultrasound diagnostics specialist Bespalov P.D., surgical nurses.
A 39-year-old resident of Volgograd was diagnosed with uveal melanoma last year, which soon metastasized to the liver. This type of disease has an extremely aggressive character and does not respond well to standard antitumor treatment.
– By August 2021, the patient had exhausted all the possibilities of traditional influence on the tumor, – Vladimir Unguryan, the chief physician of the Kostroma Oncological Dispensary, told us. – She was treated at her place of residence, then she was sent to our oncological dispensary, knowing that we had mastered a new way of treating such patients – isolated chemoperfusion of liver cancer. We performed an operation on her with good effect.
Nevertheless, despite the positive result, the method of isolated perfusion of the “open type” itself, when the liver is “removed” from the natural blood supply for a while and connected to an artificial circulation machine and performed under general anesthesia, is associated with great risks.
Therefore, the question arose about improving the method of delivery of the chemotherapy drug, and the next stage of the course of chemotherapy was decided not to be done in an “open” way, but using the method of endovascular access to the tumor. That is, through a large blood vessel suitable for the liver.
This method of “delivery” of chemo- and radiopharmaceuticals has been successfully mastered and is widely used in the A.F.Tsyba MRSC, a branch of the FSBI NMIC of Radiology of the Ministry of Health of Russia, where the largest number of radioembolizations in the country are performed. Besides, with colleagues from the Radiology Center, Kostroma oncologists have already had experience of joint operations under the leadership of the Director General of the Academician of the Russian Academy of Sciences Andrey Kaprin.
– Our common experience of conducting chemoperfusions of the liver and brain with specialists of the Kostroma Oncological Dispensary allowed us to take the next step in this direction, – says Andrey Dmitrievich, – therefore, it was decided to conduct the second stage of the course of treatment of the Volgograd patient within the walls of the A.F.Tsyba MRSC.
– Unlike “open” chemoperfusion, in our case, the solution is delivered to the tumor by performing small punctures on the skin, through which special catheters were inserted into the main vessels under X-ray control, – explains Valery Kucherov, head of the department of X-ray surgery, – such manipulation, combining two advanced techniques, was carried out by Russian oncologists among the first in the world.
Recall that liver chemoperfusion, as a method of combating multiple metastases, is described in the world and domestic literature, but is rarely used in modern oncology due to extremely complex execution techniques, and until recently could be performed only once in unabated patients. The essence of the method consists in vascular isolation of the liver and its “washing” with a high-dose solution of a chemotherapy drug of the desired temperature using an artificial blood circulation device. At the same time, the maximum concentration of the cytotoxic drug in tumor cells is achieved without harming the body.
Since 2020, the method of isolated liver chemoperfusion has been successfully used in the scientific protocol on the basis of the Kostroma Oncological Dispensary. When the issue of minimizing surgical trauma and the possibility of repeated repetition of the procedure came up in the course of work, the choice of scientific and clinical basis for the use of endovascular technique was clear. And so the first isolated liver chemoperfusion operation using endovascular drug delivery technique was performed on November 6, 2021 at the A.F.Tsyba MRSC (Obninsk).
The operation lasted 9 hours.
Despite the duration and complexity of the intervention, the patient underwent the operation well and was discharged from the hospital in a satisfactory condition after 3 days. Further clinical application of this technology will be continued within the framework of the protocol of scientific research.
Press Service of the FSBI NMIC of Radiology of the Ministry of Health of Russia