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Cirrhosis complicates decision-making when patients need liver surgery

Four experts will discuss key considerations when making surgical decisions for cirrhotic patients during Tuesday’s DDW® Clinical Symposium, Cirrhosis and Surgery: Identifying and Managing, which is co-sponsored by AASLD and SSAT.

Shimul Shah, MD, MHCM
Shimul Shah, MD, MHCM

Symposium co-chair Shimul Shah, MD, MHCM, associate professor of surgery and director of liver transplantation and hepatobiliary surgery at the University of Cincinnati College of Medicine, said evaluating cirrhotic patients for surgery is complex because there are varying degrees of illness.

“No two patients with cirrhosis are alike,” he said. “In addition to the various stages of disease, you also must consider the different problems these patients face. How do you decide which patients will benefit from surgery and which patients will deteriorate?”

Session co-chair Paul Kwo, MD, professor of medicine at Stanford University Medical Center, CA, said the session’s first two presenters will discuss how to assess patients and when to refer them for surgery.

“During the first two presentations, attendees will learn an evidence-based approach to appropriately risk-stratify patients and prepare them for surgery,” Dr. Kwo said. “When they enter the operating room, we want them in the best possible condition to have an uneventful recovery.”

Dr. Shah concurred.

“The last thing we want is for a patient to die because their liver disease was too severe and their doctor underestimated it,” he said. “If you operate when you shouldn’t, next thing you know the patient is in liver failure with no fallback plan.”

The second half of the symposium will focus specifically on liver masses. Laura Kulik, MD, professor of medicine at Northwestern University Feinberg School of Medicine, Chicago, will discuss which therapies should be considered for patients with liver masses.

“Do you call a surgeon? An interventional radiologist? A transplant surgeon?” Dr. Kwo asked. “We will benefit from Dr. Kulik’s tremendous experience on the various approaches she uses and how she tailors her approach based on the current medical literature to give every patient the best care.”

To conclude the session, Dr. Shah will discuss why patients with cirrhosis need a liver transplant if they develop hepatocellular carcinoma.

“If you have a patient with cancer, how do you decide what the right modality is, especially in the setting of cirrhosis, where they could have problems if you do something too invasive?” Dr. Shah asked. “What are the options? If you can’t go to your first option of surgically removing the cancer, what else can we do? You have to go to transplant in that scenario.”

Dr. Shah said he and Dr. Kwo planned the symposium to offer a mix of medical and surgical perspectives.

“Medical and surgical go hand in hand,” Dr. Shah said. “By the end, we hope to teach attendees that you’ve got to work side by side. Trust each other and then make the decision that’s best for the patient.”

This session will take place Tuesday, May 9, from 2 to 3:30 p.m. in Room S103. Please refer to the DDW Mobile App or the Program section of Tuesday’s DDW Daily News for additional information on this and other DDW events.

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