Physician at Work: Improving survival rates for cancer patients

As recently as five years ago, minimally invasive hepatobiliary surgery—which covers the liver, gall bladder and bile ducts—would have been inconceivable. Today, Charles H. Cha, MD, performs it routinely on patients with metastatic colorectal cancer and hepatocellular carcinoma.

According to Cha, Yale is one of only a handful of institutions where this surgery is done on a regular basis. Surgeons must first learn how to perform liver resections using open surgery before mastering the same task using the tiny incisions of laparoscopic surgery. In addition to resections, Cha also does radiofrequency ablation of liver lesions—ultrasound guides a probe that is placed directly on the liver to target small tumors.

Just a few decades ago, surgery wasn’t even recommended for patients whose cancer had spread to the liver—they were believed to have no chance of survival. Today, patients with metastatic colorectal cancer can be hopeful thanks both to improved surgical techniques and advancements in chemotherapy. “We can resect liver lesions that have spread from the colon or rectum, and patients still have survival a lot of times equivalent to if they never had a liver lesion—five year survivals of 50 percent or more in some patients,” said Cha.

When faced with a patient with multiple hepatic lesions, Cha has several options. Up to 80 percent of the liver can be removed. It will grow back within a week or two, so if he can preserve biliary drainage and blood flow to and from the liver, patients do extremely well. He can also shrink tumors with chemotherapy before surgery. A third approach is to remove part of the liver first, allow the organ to grow back to its normal size, then remove another part. Cha sometimes resects portions of the liver and ablates other portions, especially when the liver is so fibrotic that he can’t remove parts of it.

In his lab, Cha works on tumor angiogenesis, trying to target vessel growth into tumor cells in order to cut off the blood supply while tumors are still microscopic in size. In his practice, he says, every patient requires a unique approach, requiring him to alter his surgical plan accordingly. “What drew me to surgical oncology was the constant variety and intellectual stimulation it provides,” he said. “Each patient presents a distinct and unique set of challenges, requiring a collaborative effort and the need to address an innumerable number of variables, both in and out of the OR.”

Originally published in the January 2010 issue of Yale Practice.