Interview: Velina Markovska
Business Card: Prof. Dr. Nikola Kolev, D.Sc., is the youngest Associate Professor and Professor in the field of Surgery in Bulgaria. He graduated in Medicine from MU-Varna in 1998 and acquired the specialty of Surgery in 2003. He has specialised visceral, colorectal, oncological, thoracoscopic and robotic surgery, surgery of the liver, bile ducts and pancreas, minimally invasive endoscopy and laparoscopy surgery, minimally invasive surgery of the esophagus, intraoperative and endorectal sonography at leading world centres such as Los Angeles, Harvard Medical School, Boston, Pittsburgh, Fort Lauderdale (USA), Cambridge (UK), Bern (Switzerland), Milan (Italy), Hanover, Göttingen and Berlin (Germany), Seoul (South Korea), Ljubljana (Slovenia). Since 2012 he has been the head of the Department of General and Operative Surgery at MU-Varna. Fluent in English and Russian.
Prof. Kolev, under your guidance, the first in Bulgaria portal vein embolization in advanced stage of liver metastases has been performed at St. Marina University Hospital in Varna. What is the essence of such an intervention?
Portal vein embolization is a medical method in which the blood vessels supplying the metastasized part of the liver are blocked. The procedure is performed under X-ray or ultrasound control, and is carried out 2-3 weeks before the intervention for the removal of the liver metastases. The aim is to enlarge the healthy part of the liver, which in turn increases the chance for a favorable outcome of the oncologic disease.
Your team of surgeons is still the only one in Bulgaria, which successfully applies this method through which you give a chance for a new life to the patients. How often do you perform such interventions?
I can say that this has become a routine surgery for our team. Unfortunately, the incidence of liver metastases has been increasing in proportion to the increase of oncological diseases. The liver is a unique organ which performs functions that are vital to the human body. All organs are related to the liver, so when a cancer disease occurs somewhere in the body, it may spread and get into the liver. This process is called manifestation of liver metastases.
What specific actions do you take when liver metastases are diagnosed?
It is obligatory to perform tests in order to find out where the metastases come from. Our goal is to remove the primary tumor, while at the same time we clean the liver from the secondary tumors - metastases. For each individual patient and each case we create an individual strategy and approach, which is aimed at releasing the body from the last possible tumor cell. Exactly this kind of treatment strategy is created by a multidisciplinary team of doctors, headed by a surgeon.
Do liver metastases occur often?
The liver is a frequent location of malignancies. Carcinomas of the lung, colon, breast, pancreas and stomach cause liver metastases respectively in 25%, 16%, 11%, 10% and 6% of all patients, and ovarian, endometrial and prostate cancer – in less than 4% .
Is it possible patients with liver metastases to be cured?
That is probably the question that patients ask me most frequently. My answer, based on plenty of years of experience, working at leading hospitals around the world is: Yes, the most important is the patient to find a qualified liver surgeon, experienced in this disease, who can create the most successful strategy for achieving a successful outcome.
At present we observe an increased number of patients who are diagnosed with occurrence of metastases at the first examination, i.e. in Bulgaria we don't have timely diagnosis and prevention. The fact that there are metastases does not mean that the patient is doomed because modern medicine allows both the tumor and the metastases to be removed, so prevention is of crucial importance. People themselves should be aware of that necessity, and they should not rely only on the state and blame the so-called "Reform" for that, because this is a problem to everyone, and if someone is late, the guilt and consequences are at his own expense.
Prof. Kolev, what would you recommend to patients?
My recommendation to everyone is to undergo preventive check-ups once a year, because the earlier an oncology disease is diagnosed, the more rapid and favorable outcome can be expected. A large percentage of tumors are genetically determined. Prevention is mandatory for patients who have relatives who have suffered or died of cancer. Years ago it was believed that cancer occurred predominantly in elderly and old people, but nowadays more and more frequently we observe, and we need to operate younger patients. This requires lowering the starting age for preventive check-ups.
St. Marina University Hospital in Varna provides a full range of equipment and specialists to perform prevention, to diagnose, to determine the stage of tumor process, to plan and perform integrated treatment to the fullest extent. In our Clinic we operate all kinds of oncological diseases of the digestive system – esophagus, cardio-esophageal junction, stomach, pancreas and duodenum, biliary system, liver, small intestine, colon and rectum, peritoneum, pleura and lung, retroperitoneum, adrenals, and a priority is given, in correspondence to the global trend, to bloodless surgery or the so-called in Medicine laparoscopy surgery. The advantages of bloodless surgery are less trauma and postoperative pain, shorter hospital stay, faster initiation of postoperative chemotherapy and radiotherapy, which are often a part of the integrated cancer treatment.
Can you explain what integrated treatment means, and whether you need any special equipment?
The treatment of a metastatic disease and its treatment strategy consists of numerous stages. At each stage the different specialists use a variety of equipment. If the chain of the healing process is interrupted, the treatment loses its meaning, and the disease returns to its starting position, i.e. the treatment should be constant and consistent. Therefore it is called integrated. In order to undergo a proper integrated treatment, the patient needs to get into a hospital where there are conditions enabling the whole cycle from diagnosis to treatment to be completed, so that it will not be interrupted due to various circumstances. I can boldly say that integrated cancer treatment at St. Marina - Varna brings successful outcomes. This is an essential prerequisite that guarantees the curing of cancer.
In fact there are just few centers in Bulgaria like this one. There is only one centre at St. Marina University Hospital - Varna for the entire territory of Eastern Bulgaria. No other hospital in the region possesses the full range of equipment and specialists required to close the cycle of treatment, and the disease to be cured, without giving it a chance to return to the human body again. The necessary equipment and units are as follows: polyclinic specialists in direct contact with the hospital; a complete modern diagnostic panel-diagnostic imaging, endoscopic unit, morphology with an option for immuno-histochemical and genetic profiling, PET/CT, intensive care clinic of the highest class, colorectal surgery, hepatobiliary surgery, laparoscopic surgery, interventional radiology and interventional endoscopy with an option for intervening in the liver tree, embolization of liver vessels and percutaneous treatment of liver formations, a qualified Oncology Committee, Clinic for Medical Oncology, Clinic for Radiotherapy with available equipment of the highest modern class, immunology, psychology support unit, polyclinic and hospital unit for tracking the disease. The leading role in the treatment of tumors of the digestive system and their metastases belongs to the surgeon because he/she removes the tumor.
If a patient with liver metastases does not have the opportunity to get into a centre that meets the above-mentioned conditions, the risk for him is extremely high, and the price paid is usually the health and life.