In the Irkutsk regional hospital, a giant liver tumor was removed for the first time

In the Irkutsk Regional Clinical Hospital, surgeons successfully removed a giant liver tumor over five liters from a woman. The four hour operation required teamwork to handle massive blood loss and avoid complications. The patient had been monitored for years, and surgery was chosen when signs of liver failure appeared and the risk of fatal bleeding became real.

Surgeons at the Irkutsk Regional Clinical Hospital performed a delicate operation. They removed a giant liver tumor from a woman — more than five liters in volume. According to Alexander Novozhilov, head of the portal hypertension department at the IRCH, such a large tumor has not been operated on at the clinic for a very long time.
The resident of the Nizhneilimsky District first came for a consultation with IRCH surgeons five years ago, and at that time her condition caused no concern. But over the next four years, the tumor grew significantly in size.
– Since the patient developed signs of liver failure, and the danger of the tumor rupturing with fatal bleeding became real, it was decided to perform surgery, – the surgeon said.
The operation lasted four hours.
– Removing a tumor of this size is technically very difficult in itself, – Alexander Novozhilov noted. – The situation was complicated by the expected significant blood loss, which is inevitable in such interventions, but the anesthesiologists helped us greatly here. They enabled us to work normally by preventing possible emergency situations.
– There were two independent risk factors that had to be taken into account, – said Igor Karetnikov, deputy chief physician of the IRCH for anesthesiology. – First, it was a large vascular tumor; second, the very nature of the liver’s structure. Interventions on this organ are usually accompanied by massive blood loss. Therefore, several catheters were placed in advance, including a high-flow one, to ensure effective vascular access, and the necessary supply of plasma and red blood cell mass was also prepared.
In fact, blood loss amounted to almost two volumes of circulating blood (about seven liters), and it was massive both in volume and in rate. To compensate for it, a cell saver was used — a device that collects blood, cleans it, and returns it to the bloodstream. The surgeons had to switch it to manual mode, since in automatic mode the replenishment was not as effective.
– This caused some disturbances in the blood clotting process, – Igor Karetnikov noted. – And here our colleagues from the Center for Laboratory Research helped us greatly by precisely determining the cause of the malfunction, as did the hematologists, who suggested using a prothrombin complex, which is usually used in the treatment of hemophilia.
– The coordinated work of surgeons, anesthesiologists-resuscitators, transfusiologists, and hematologists made it possible not only to successfully perform the operation, but also to avoid possible complications in the early postoperative period: bleeding, acute renal and hepatic failure, and acute lung injury, - Alexander Novozhilov concluded. – The woman can be considered fully cured, however, she will remain under our observation.