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A multidisciplinary team of sub-specialists has introduced advanced minimally invasive treatments for liver conditions for the first time in the Eastern Cape, with the establishment of the Liver Centre SA in the Cape region, marking a significant step forward for healthcare in the region.

“We congratulate Dr Andries Steenkamp, Prof Marc Bernon, Prof Mark Sonderup and Dr Dale Creamer and the Cape Town Interventional Radiology team on their initiative in developing these world-class multidisciplinary liver disease services,” says Alan Abrahams, Netcare’s Cape regional manager.

Liver Centre SA is represented at both Netcare Greenacres Hospital in Gqeberha and Netcare UCT Private Academic Hospital in Cape Town.

“Liver diseases are a significant and growing health concern, and unfortunately many people and their doctors across the Cape provinces require a multidisciplinary centre focused on the hepatobiliary system for diagnostics or treatment of conditions affecting the liver, gall bladder, bile ducts or pancreas,” says Dr Steenkamp, a hepato-pancreatico-biliary and general surgeon practising at Netcare Greenacres Hospital.

Recently, Canadian-trained interventional radiologists Dr Dale Creamer and Dr Gercois Human, along with Dr Jateel Kassim, the first Interventional Radiology Fellow in South Africa, have extended the latest minimally invasive techniques to the treatments and surgical options provided by the multidisciplinary Liver Centre SA team at Netcare Greenacre’s Hospital.

For the first time in the Eastern Cape, three groundbreaking interventional radiology procedures, transjugular intrahepatic portosystemic shunt (TIPS), transarterial chemoembolization (TACE) and transarterial radioembolization (TARE), were performed in the hospital’s state-of-the-art catheterisation laboratory (cath lab).

Pic: Dr Andries (AB) Steenkamp, a hepato-pancreatico-biliary and general surgeon (far left), is pictured with the Netcare Greenacres Hospital theatre team, part of the recently established Liver Centre SA multidisciplinary team, which is extending the options for the diagnostics and treatment of conditions affecting the liver, gall bladder, bile ducts or pancreas in the Eastern Cape.

 

Pic: Canadian-trained interventional radiologist Dr Dale Creamer (back right) is pictured with unit manager Lyall Nelson and the cath lab team at Netcare Greenacres Hospital, where minimally invasive, highly targeted image-guided treatments have been introduced alongside traditional surgical interventions.

 

“These minimally invasive procedures do not require traditional surgery to reach the site in the liver requiring treatment. The TIPS procedure is used to treat upper gastrointestinal bleeding, that is, blood in a person’s vomit, as well as refractory ascites, which refers to an accumulation of fluid in the abdomen despite treatment for cirrhosis. The aim of the TIPS procedure is to create a bypass via a stent through the liver,” Dr Creamer explains.

TACE is a minimally invasive interventional radiology procedure that treats liver tumours by injecting chemotherapy directly into the artery that feeds the tumour, followed by embolisation to block the blood flow, thereby depriving the cancer of ‘fuel’.

In addition to Dr Steenkamp and the Cape Town Interventional Radiology doctors, the Liver Centre SA multidisciplinary team at Netcare Greenacres Hospital includes hepatobiliary surgeon Dr Wanga Mtimkulu, gastroenterologist Dr Nimrod Mokhele, and oncologist Dr Marike Samoo, offering a comprehensive range of subspecialist expertise and treatments in the heart of the Eastern Cape. The multidisciplinary team collaborates to leverage the benefits of their expertise for each patient, providing an informed basis for shared decision making.

The multidisciplinary team is now also able to include TARE among the options available to treat liver cancers. This treatment works by delivering radiation directly to the tumour from within the blood vessels,  providing highly targeted radiation exactly where it is needed while sparing healthy liver tissue.

Lyall Nelson, unit manager of the cath lab at Netcare Greenacres Hospital, explains that interventional radiology procedures are performed in a specially equipped theatre, with diagnostic imaging equipment used to visualise the vascular system and guide treatment through minimally invasive interventions.

“The highly experienced radiographer assists the interventional radiologist with real time imaging to guide these intricate, highly targeted treatments on the liver, gallbladder and pancreas percutaneously and via the peripheral vascular system. The anaesthetist and our specially trained cath lab nurses continuously monitor the patient, who remains sedated under general anaesthetic for the procedure, with the involvement of other specialists as needed,” he explains. 

These less invasive procedures can, in appropriate instances, offer patients a crucial alternative to open abdominal surgery, significantly reducing the associated physical trauma while cutting recovery times from weeks to days in many cases.

Dr Steenkamp emphasises the team effort required from all quarters to develop comprehensive liver workups and treatments that can bring hope to more people with liver-related concerns, some of whom were previously inoperable.

“We could not have achieved this without the relationships that underpin the services to our patients, and we are immensely grateful. The leadership and support of Netcare and hospital management, the dedication to excellence of the surgical theatre and cath lab team, the commitment from all the specialists to person centred care, and the vigilance of referring healthcare professionals in recognising signs of liver disease,” he says.

“The introduction of these technologically advanced and person centred liver health and care hubs is an asset not only to the Cape region, but also to patients and referring healthcare professionals nationally,” Dr Steenkamp concludes.

For more information on Liver Centre SA, please visit www.livercentresa.co.za.

Liver cancer’s surprising risk factors and symptoms

Primary liver cancer (hepatocellular carcinoma) occurs when a malignant tumour originates in the liver rather than spreading from elsewhere in the body.

According to CANSA, the following factors may increase the risk of developing liver cancer:

• Eating food contaminated with aflatoxins: maize, peanuts, tree nuts, and other foods that are incorrectly stored and exposed to warm, humid conditions can develop microscopic fungi that produce carcinogenic (cancer-causing) aflatoxins.
• Alcohol is also a Group 1 carcinogen, and long-term use can cause liver scarring, which increases the risk of liver cancer.
• Non-alcoholic fatty liver disease.
• In Asia and Africa, liver cancer diagnosis is most common between the ages of 20 and 50 years.
• Men are more prone to liver cancer than women, but anyone could be at risk.
• Certain liver diseases, including haemochromatosis and Wilson's disease, are associated with a higher risk.
• Obesity increases the risk of liver cancer, among other types of cancer.

Often, liver cancer does not have noticeable early symptoms. If you notice the following symptoms, consult a healthcare professional without delay:

• Loss of appetite
• Pain in the upper abdominal area
• Nausea and vomiting
• Unintentional weight loss
• Feeling weak and unusually tired
• Distended abdomen
• Jaundice (the whites of the eyes may turn yellow, with yellowing of pale skin) 
• Dark-coloured urine
• Pale stools that may have a ‘chalky’ appearance
• Fever
• Bruising or bleeding easily

Reference: CANSA Liver Cancer Fact Sheet. https://cansa.org.za/files/2021/03/Fact-Sheet-on-Liver-Cancer-NCR-2017-web-March-2021.pdf

Ends

Notes to editors
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