Helios Berlin-Buch: Successful treatment of liver metastases with surgical ALPPS procedure

20/06/2024 07:06

Prof. Dr. med. Roger Wahba is an expert in the field of liver surgery and has been Chief Physician of General, Visceral and Oncological Surgery at Helios Hospital Berlin-Buch since August 2023. He has now performed an ALPPS operation (Associating Liver Partition and Portal Vein Ligation) here for the first time, successfully treating a 44-year-old patient. All of the young mother's liver metastases were removed in a two-stage surgical procedure. The major liver surgery operation marks a new approach to liver surgery at Helios Hospital Berlin-Buch and probably saved the patient's life.

Anika Hofmeister will never forget September 15, 2022. It was not only her best friend's birthday, but also the day on which the then 42-year-old was diagnosed with bowel cancer. The cancer had already spread. This diagnosis marked the beginning of the mother-of-two from Ahrensfelde's long battle against cancer, which also took her to the Helios Hospital Berlin-Buch and to Prof. Dr. med. Roger Wahba at the beginning of the year.

I did not start this war, but I will win it.

At the time of the initial consultation in Berlin-Buch, Anika Hofmeister had already undergone several chemotherapies and a surgical procedure in other hospitals: "After being diagnosed with stage 4 bowel cancer, I was operated on very promptly. During the first operation, the primary tumor as well as the spleen and parts of the pancreas were removed. This was followed by a total of 29 rounds of chemotherapy." The young patient was informed at the start of treatment at the end of 2022 that a further surgical procedure would be necessary to remove her liver metastases.

The chemotherapy was effective and in April 2023, Anika Hofmeister was deemed fit for surgery for the first time. However, during the necessary six-week preoperative chemotherapy break, the metastases in her liver increased so much that the scheduled operation had to be canceled. "At that moment, I just thought to myself, I don't want to go on, I can't go on, I'm going to stop the treatment," Anika Hofmeister recalls. The lengthy and exhausting cancer treatment had left both physical and psychological scars.

In order to counteract the symptoms of exhaustion and psychological complaints, Anika Hofmeister continued her oncological treatment as part of a "strength-get-rehab" program and received a positive prognosis at the end of last year: "My oncologist called me during rehab and told me that the liver metastases were responding to the chemotherapy and that I was fit for surgery again. At that moment, she was also the one who directly put me in touch with Prof. Wahba as a specialist," says Hofmeister, describing the moment that gave her renewed confidence.

Successful cancer treatment with the ALPPS procedure

"Due to the large number of metastases in Ms Hofmeister, we decided to use our liver surgery expertise to perform a two-stage liver resection using the ALPPS procedure," explains Prof. Wahba, who specializes in liver surgery, particularly for extensive metastases.

"The special thing about this surgical procedure is that the liver cannot be operated on immediately because there are so many metastases. As a rule, the left part of the liver has fewer metastases. Therefore, the existing metastases in the left part of the liver are removed first, the blood flow to the right half of the liver is blocked and the blood is diverted to the left part of the liver, which is then tumor-free. The left, now healthy part of the liver can then grow back quickly. After around two to four weeks, there is sufficient liver tissue so that the right metastasized part of the liver can be surgically removed"

- Prof. Dr. med. Roger Wahba, FEBS, Chief Physician General, Visceral and Oncological Surgery | Helios Hospital Berlin-Buch

In the case of Anika Hofmeister, Prof. Wahba surgically removed over two-thirds of the affected liver in both operations.

The first part of the operation was performed on Anika Hofmeister in January 2024. While the healthy liver tissue had to increase in volume afterwards, the patient was able to recover at home from the stresses and strains of the major procedure. In preparation for the second operation, she received comprehensive care and examinations from the team of experts at Helios Klinikum Berlin-Buch. "Before the second liver surgery, a 3D model of the liver is created, the healthy part is measured and its volume is calculated. The second operation can only be scheduled if all the results are correct and the formation of new tumors has been ruled out. It is important that all factors are clarified for such a major operation, which also carries risks, and that the necessary framework conditions, such as a well-equipped intensive care unit, are in place," says Prof. Wahba, describing the need for a holistic approach to the case.

In the case of Anika Hofmeister, who was the first patient to be treated with the ALPPS procedure by Prof. Wahba at Helios Hospital Berlin-Buch, the operation went very well.

"Even though I perform around 2,000 to 2,500 surgical procedures per year with my team, this type of procedure is really rare. I treat around three patients a year using this method."

- Prof. Dr. med. Roger Wahba, FEBS, Chief Physician General, Visceral and Oncological Surgery | Helios Hospital Berlin-Buch

Under the right conditions, this procedure can also be performed in a minimally invasive robot-assisted manner.

A positive view of the future

Ten weeks after both operations, Anika Hofmeister's liver has almost returned to its original size. And the patient is also looking to the future with a smile on her face: "My old self is back. Of course, the large scar reminds me of the operation and of course I'm also afraid of the next check-up appointments, but I'm full of confidence and looking forward to my upcoming rehab."

Prof. Roger Wahba is also extremely satisfied with the outcome of the procedure: "We have created the best conditions for Ms. Hofmeister. Unfortunately, you never know how cancer will develop. If the metastases come back, we have various options for treating her again. From a repeat operation to thermal ablation and special radiotherapy, many things are possible at our clinic."

Anika Hofmeister remains optimistic for her sons alone, "if there is a setback, I know who I can always turn to with confidence."

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