This year, approximately 41,630 new cases of liver cancer are expected to be diagnosed in the United States. With incidence rates more than tripling since 1980, liver cancer is a leading cause of cancer-related deaths globally. While multidisciplinary care varies per patient, liver cancer treatments may include a combination of surgery, chemotherapy, radiation therapy, immunotherapy, and other targeted therapies.
 
As cancer care evolves, Shaun P. McKenzie, M.D., FACS, surgical oncologist at Texas Oncology Surgical Specialists–Round Rock, and South Austin, discusses two surgical procedures, histotripsy and hepatic artery infusion (HAI) pump therapy, redefining the future of liver cancer treatment and outcomes.
 
1) What are histotripsy and hepatic arterial infusion? How is each procedure performed?
Histotripsy is a noninvasive technique used to destroy tumors, particularly in the liver. This outpatient procedure uses high-frequency intensity ultrasound waves to create a “bubble cloud” designed to destroy tumors while preserving nearby critical blood vessels and bile ducts.
 
Hepatic artery infusion (HAI) pump therapy is a surgical procedure used to deliver chemotherapy directly to metastatic tumors in the liver. During the procedure, an infusion pump is inserted into the abdominal wall while a catheter is directed to the hepatic artery, which supplies blood to the liver.
 
2) Who may be an ideal candidate for these procedures? What liver conditions or tumors are typically considered for these procedures?
For both procedures, a candidate’s cancer must be localized to the liver or well-controlled by other therapies if outside of the liver. The candidate should also be able to tolerate general anesthesia and have preserved liver function.
 
Histotripsy is typically offered to patients who have a limited number of tumors and are otherwise not a candidate for traditional surgery. While there’s no strict size limit, tumors often treated with this procedure are under 4 centimeters and can be seen easily on an ultrasound.
 
HAI pump therapy is indicated for patients with colorectal cancer that has spread to the liver or those with bile duct cancer within the liver. This procedure is usually for patients who cannot have their tumors surgically removed or those at a high risk for recurrence after surgery.
 
3) What are the benefits of each procedure compared to other surgical and non-surgical liver cancer treatments?
Histotripsy is noninvasive, and we’re able to confirm the destruction of the tumor in real-time. Histotripsy can also be performed in combination with other ongoing cancer treatments with no interference or delays in the other treatments. This technique preserves critical blood vessels and bile ducts and can treat tumors otherwise not removable. Additionally, patients may experience minimal symptoms and manageable side effects afterwards.
 
HAI pump therapy is beneficial for patients with advanced colorectal or bile duct cancer in the liver where only systemic chemotherapy is viable. This procedure can be performed in conjunction with other liver or organ surgeries and has fewer side effects than oral or intravenous chemotherapies.
 
4) As a surgeon, how are these procedures shaping the future of cancer care and specifically liver cancer?
Both procedures have the potential to redefine the treatment of liver tumors or other cancers that spread to the liver. Histotripsy offers patients a surgical option that’s not only noninvasive but more effectively treats liver tumors while significantly enhancing other novel cancer treatments. This approach, while preserving liver function, also stimulates an immune response to the patient’s cancer.
 
HAI pump therapy has the unique ability to directly target the liver, offering a promising future for intensive liver therapies with fewer systemic side effects and improved surgical outcomes for cancer patients.
 
5) What advice would you give patients when deciding on surgical treatment options for liver cancer?
Liver cancer is a complex disease that requires a diverse treatment plan. I always encourage patients to consult with a surgeon who specializes in liver tumor treatment and supports a range of comprehensive care options in addition to surgery.
 
To learn more, visit Texas Oncology Surgical Specialists or schedule an appointment to determine if you or a loved one may be a candidate for one of both of these innovative liver cancer procedures.