Key Liver Conditions
ACUTE LIVER FAILURE
The outcome of patients with ALF remains very poor in developing countries with high mortality. There are at least 7000-12,000 patients who suffer from ALF every year in India, of whom approximately 1200-2000 patients are too ill and die without a liver transplantation (LT). We have established a programme that places emphasis on the care of such patients. ALF affects young people (average age 20-40 years) in the prime of their lives and strikes previously fit people. Although the chances of death are about 80% without appropriate treatment, 80% can survive with the right medical care, including transplantation.
LIVER & PANCREATIC CANCER
Liver cancer is the fifth most frequently diagnosed cancer and the second leading cause of cancer deaths. Both hepatitis B and C cause cirrhosis and
cirrhosis is the greatest risk factor for hepato-cellular cancer (HCC). Indeed, as you all know, with chronic Hepatitis B, patients can develop HCC
even before they develop cirrhosis and their relative risk of HCC is 100-fold higher, compared to the normal population.About 5 to 10 per cent people
with HBV or HCV will develop liver cancer. For such patients cure is only possible with liver transplantation surgery (when the liver is cirrhotic)
or liver resection. While there are many ways of treating liver cancer like radio frequency ablation, chemotherapy, etc, surgical removal is the only
treatment that can cure; other modalities only increase survival by months, generally. Major surgery in cirrhotics is a complex undertaking, which
must be performed in centers with experience in managing liver failure.
LAPAROSCOPIC (KEYHOLE) LIVER SURGERY
Liver surgery is complex as compared to most other abdominal surgeries. The lack of anatomical landmarks to guide surgery and large blood flow through this organ makes dissection difficult. Moreover, the presence of vital structures in the vicinity allows for a very small margin of error. Therefore, despite keyhole surgery becoming popular for most other organs over 15 years ago, laparoscopic liver surgery (LLS) has only been performed by a relatively few surgeons. There is enough evidence to suggest that for certain liver operations, when compared with open liver resection, LLS appears to provide comparable mortality (0.3%), shorter hospital stay, improved complication rates (overall complications are about 16%, compared to 22% in open surgery) and better cosmesis, cost effectively. Of course, feasibility also depends on the type of and the site of the tumor. LLS in patients with chronic liver disease is indeed safe and, in fact, better than open liver surgery in terms of reduced post-operative complications operating time and blood loss. Concerns about a higher cancer recurrence have now been disproved.
Non Alcoholic Fatty Liver Disease (NAFLD)
Recent studies confirm that fatty liver is now the fourth most common reason for liver transplantation in the USA. Furthermore, it will soon become the
leading indication for liver transplantation worldwide! Recent community-based studies from Asian countries, including Japan, China, and India, indicate
that the overall NAFLD prevalence is as high as 45%.
We at CARE Hospitals have keen interest in children with liver disease. In order to optimize results we are trying to consolidate our pediatric experience at one centre.