RENOWNED: UK-based consultant liver and pancreatic surgeon Dr Neil Pearce. —Photo: MICHEAL BRUCE

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Hope for liver surgery patients

By Verdel Bishop

A number of patients suffering with various tumours of the liver including a 16-year-old girl, Shelomith Thomas, who has had a five and a half pound cancerous tumour removed from her liver underwent successful operations recently by a team of specialists headed byUK-based consultant liver and pancreatic surgeon Dr Neil Pearce.

Pearce, a consultant general surgeon specialising in surgery of the liver, gall- bladder, bile ducts and pancreas, who has pioneered the development of keyhole liver surgery in the UK since 2003, has performed six major surgeries and 30 hours of operating during March 23 to March 25, in which various techniques were used to give his patients new leases to life. A BBC Healh Correspondent was on hand to document the delicate surgeries.

Following his final surgery last Friday, at West Shore Medical, a private hospital in Crocoite, Dr Pearce, who is also a Director of Advanced Laparoscopic Liver and Pancreatic Surgery (ALLPS) UK and ALLPS Caribbean, lamented the crippling shortage of medical specialists in Trinidad and Tobago. He said specialists achieve better outcomes than generalists.

"Trinidad has got some fantastic oncologists and really good access to the chemo side of things. But at the moment you don't have a really specialised liver surgery service.

There are surgeons who like to operate on the liver and they do, but the trouble is if you are only operating on the liver three or four times a year or once or twice it is very hard to get specialised and the liver is probably the most difficult abdominal organ to operate on with the highest risk. If you are just going to occasionally operate on the liver then the risk to the patients' life could be 20-30 per cent but if you do it routinely and regularly then you can take on difficult cases; like Shelomith Thomas, the risk to her life was about two per cent and most of the other operations we've done over the week was less than one per cent. That's because it's not just about skills, it's about experience and having the right equipment," Dr Pearce explained.

Pearce said there is room for T&T to have an effective functioning liver surgery service. "We are providing a service which is not available here in Trinidad. There are four of us who are on rotation and we come to Trinidad when there are cases available. We are out of the UK about six times a year. I usually come out about three times a year. In the long term we want to see Trinidad surgeons sub-specialise more.

"Most of the islands in the region are too small to have a sub-specialist service however, Trinidad is in a position to sub-specialise because population is over one million. I think that there are too many doctors who dabble. There are too many who are great as surgeons and they just want to be able to do everything and they need to realise that if you want to gain great clinical respect then you need to specialse. When you are in a health care economy like Trinidad you have to sub-specialise. I am happy to help out with really difficult cases but I see definitely that Trinidad needs to have a self-sustaining and effective liver surgery service," the surgeon said.

Pearce said West Shore facility has state of the art equipment which is not available anywhere else in the region. "West Shore has all the necessary equipment because we've brought them in, one-by one, since we first began performing surgeries here in 2009. This facility has everything from harmonic scalpels to a laparoscopic ultrasound machine, most of which is not available anywhere else in the region. All we need now are more liver specialists," Dr Pearce said.

Dr Pearce revealed that 16-year-old Shelomith Thomas was a difficult case. His colleague, Dr Tim John led this case surgery. "It was as difficult as we had expected. If this had been a small tumour we could have done it as a key hole operation, which might have just lasted two hours. There was five and half pounds of cancer and all these massive blood vessels around. She is just 16-years-old. She has been unwell for about a year and getting progressively worse.

The tumour was starting to impact on her physical fitness. She was deteriorating to the point where she had to have an operation. This was her last chance to live and we are really happy that we were able to help," Dr Smith said.

Dr Smith explained that Thomas had a fibrolamellar hepatocellular carcinoma (FHCC), a rare form of cancer that typically affects young adults and is characterised, under the microscope, by laminated fibrous layers interspersed between the tumour cells. Approximately 200 new cases are diagnosed worldwide each year. There has been limited research and progress toward understanding its cause and how best to treat it.

There are no specific symptoms for FLL-HCC. Patients may report pain and/or a mass in the abdomen; feeling bloated, tired, weak, or generally unwell; or having nausea and/or vomiting.

"They are often presented by really big lumps and affect young people between ages 15 and about 25. Young people are fit so they could usually put up with something growing inside to them for quite a while; a classic presentation is a massive haemorrhage and by that time it's too late. Quite often they rupture," Dr Pearce said. It is painful and uncomfortable it presses on your stomach and it's difficult to eat.

They push up on the diaphragm so it's hard to breathe and it's a terrible way to go. Her surgery took almost five hours.

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