Liver Resection and Portal Vein Embolization 9-7-23

9/6/23

We arrived at the hospital at 6:15 am and checked in. They got him all set with his IV and wheeled him back around 8.
He got a few nerve blocks in the OR to help with pain and then they made the first cut at 9:30ish.
I got my first update around 1, which was an hour later than anticipated. You bet I kept asking for that update starting at 12:15 too. The nurse liaison updated me with - “his vitals are stable and they removed the specimen. Your next update will be in 2 hours either from me or the doctor if he is out of surgery.”

Ashley (my older sister) and I ate some lunch and headed back up to the waiting area.
15 minutes later the doctor came out to tell us that they moved forward with the left side liver resection. There were no new surprises on the right side of the liver when he ultra-sounded it.

Before we get into the surgery details here is a little liver biology lesson. The liver is made up of two lobes the left and the right. The right side is the dominant side at 58% of 100%. The left lobe is 42% of the 100%. It is split by the falciform ligament and the portal vein is to the left of the ligament. The portal vein is the blood supply to the liver and splits to feed the left and right lobes.

On the left side, there was a larger tumor and a small nodule on the ligament that attaches the liver to the peritoneal wall, a dilated bile duct, and a small tumor they couldn’t see on the CT scan. They removed about 20% of his left lobe (all the cancer in the left lobe) which means there is 20%ish of healthy left of the left lobe.

In order for them to proceed with resecting the right side they would need to have left 30% of healthy liver in the left lobe. Over the next few weeks until his scan in October, he needs his liver volume on the left side to grow to get him to 30%.

9/7/23

The Portal Vein Embolization (PVE) was a procedure that was supposed to happen this morning, but his bilirubin levels were slightly elevated which shows that his liver was a little traumatized by the resection yesterday. A PVE (portal vein embolization) is where an interventional radiologist will insert a needle guided by imaging to specific veins in the liver to block blood flow to the right lobe, which will direct more blood to the left lobe to encourage faster growth. If they continued with the procedure this morning with the elevated bilirubin levels it would have caused fluid to build up in his belly which would be painful and silly.

The plan is to repeat blood work next week and do the PVE next week sometime before we head home. It is an outpatient procedure so it won't be too hard.

Even though there is a slight delay in the PVE, we trust that the doctors have his best interest in mind. It doesn't change the plan to do the right liver resection in October.

I did mention earlier he needs his left lobe to grow 10% in order for the right liver resection to happen. The other benchmark is that he can't have any new cancer tumor growth in the left lobe between now and the scan either.

We are blessed by the peace we have felt and the love and support of those around us. We continue to be thankful to the Lord for his blessings and faithfulness.

Please continue to pray for Zach's recovery and that we have the courage and discernment to follow God's will.

-Amber

P.S. If you have questions please leave a comment. I am writing this after a few hours of sleep.