International liver trial could transform surgery for patients

A series of clinical trials taking place at BHP founder member University Hospitals Birmingham NHS Foundation Trust (UHB) could change the way liver operations are performed worldwide.

The international ORANGE 2 Plus trial compares two types of surgery – keyhole surgery and open surgery – for performing a hemihepatectomy, an operation which involves the removal of half of the liver. The current standard is to use open surgery for major operations, such as a hemihepatectomy, and to use keyhole surgery for minor or smaller operations.

“We were delighted that UHB became the joint highest recruiter to the trial in the UK, and third highest in Europe. This success was made possible by the dedication and commitment to the trial by all members of the research team at UHB, and in particular I would like to thank Ravi Marudanayagam, Diana Hull, Penny Rogers, Emma Burke, Pamela Jones and Davinia Bennett.

“Although keyhole surgery is much more challenging and takes longer to perform than traditional open surgery, other trials on minor liver resections have suggested that it is beneficial for patients, and it will be interesting to see if these benefits are also seen for major liver resections.”


Robert Sutcliffe, Consultant in Hepatobiliary and Pancreatic Surgery
L-R: Ravi Marudanayagam, Robert Sutcliffe, Pamela Jones, Penny Rogers

Keyhole surgery was first used for simpler operations such as the removal of the gall bladder, but has been used increasingly in recent years for a range of surgical operations.

Although keyhole surgery is not a commonplace treatment for liver operations, there are several specialist centres around the UK that regularly perform keyhole surgery, including UHB.

The liver research team at UHB, led by Robert and Ravi Marudanayagam, have recently started recruiting patients into two further trials.

 The ORANGE Segments trial is assessing the potential benefits of keyhole surgery for the removal of liver tumours in difficult to access locations, with the DIPLOMA trial also assessing the potential benefits of keyhole surgery for the removal of cancerous tumours in the pancreas.