Three-quarters of liver removed to treat cancer in 66-year-old Abu Dhabi schoolteacher

“It sounds so strange that an itch can be a sign of cancer,” Yost said, referring to a sudden itch in his body that turned out to be a sign of cancer. The Abu Dhabi resident had initially only visited a dermatologist to have his itch treated, but the pills and ointments he was prescribed did not help.

Cancer detected

Additional blood tests and scans then revealed the cancer in his gallbladder and bile duct — a series of tubes that carry a fluid called bile to the small intestine for the digestion of fats.

Yost’s doctors told him that his bile ducts were blocked because of the cancer.

“It was all the bile building up in my body that caused the itchiness, as well as the jaundice I was experiencing. Twice, the doctors tried to put stents in so that the bile could flow into the small intestine again, but had no luck,” Yost added.

Biliary drain

A biliary drain was then attempted, where the bile was collected in a bag outside his body. “I had that pouch on me for a couple of weeks before the hospital recommended that I transfer to Cleveland Clinic Abu Dhabi for the complex surgery to remove the cancer,” Yost said.

Dr Naveed Ahmed, the hepato-pancreatico-biliary surgeon (liver, pancreas and bile duct) at the hospital’s Digestive Disease Institute, treated Dale with the help of a multidisciplinary team of physicians, dieticians and wound-care nurses in November 2020. He said the attempt to clear the blocked bile ducts and relieve the symptoms of jaundice with stents was a success. This approach was necessary to continue Yost’s treatment to remove the cancer.

Removal of liver

The medical team at Cleveland Clinic Abu Dhabi had to carry out a central hepatectomy, whereby they had to not only remove the bile duct and gallbladder completely, but also had to resect three-quarters of Dale’s liver to cure him.

“About 90 per cent of gallbladder cancers are unresectable, so treating Dale with this procedure is quite uncommon. The surgery required a lot of technical capability and a team with expertise in interventional radiology, advanced endoscopy, gastroenterology and wound care,” Dr Ahmed said.

Regenerative organ

He also explained that the decision to remove a significant portion of the liver, as was done in Yost’s case, is very rare.

“If the cancerous growth is on the periphery of the liver, you only need to remove the diseased portion. But for central tumours like Yost’s, we have to remove the healthy part of the liver as well to prevent it from spreading,” Ahmed said. How much of the liver is saved also determines whether the liver can regenerate after resection.

“If the remnant portion is small for the size of the patient, it can be fatal. In Yost’s case, where the cancer had spread outside the liver, a liver transplant was not an option either. We were lucky that we could preserve a healthy portion, making it possible to save his liver,” Dr Ahmed said.

Yost’s latest liver-related tests show that his liver has grown to a normal size. He is currently undergoing chemotherapy, and plans to retire at the end of the year.

Advanced treatment

Yost, a father of three, said his family had initially wanted him to return home to Canada for treatment. “If this had happened back home, I would have avoided seeing a doctor because of the long waiting time to get an appointment. The health-care facilities in Abu Dhabi, and Cleveland Clinic Abu Dhabi in particular, are superior. You just walk in and an integrated team of physicians, surgeons, dieticians and wound-care nurses are by your side to aid your recovery,” he said.