Liver surgery
Liver surgery is typically performed for liver cancers, and less commonly, for benign conditions such as benign liver lesions, liver cyst, or stones within liver known as hepatolithiasis.
Liver cancers can be primary (arising from liver) or metastatic (spread from other cancers e.g colorectal cancer, neuro-endocrine tumours etc). The primary liver cancers could arise from liver parenchyma (hepatocellular carcinoma) or from biliary tract within the liver (cholangiocarcinoma). In Australia, the commonest indications for the liver surgery is colorectal metastasis.
The liver is located in the upper right-hand portion of the abdominal cavity, beneath the diaphragm, and on top of the stomach, right kidney, and intestines. Shaped like a cone, the liver is a dark reddish-brown organ that weighs about 3 pounds.
The liver consists of two main lobes – right and left. Both are divided into eight functional segments of lobules based on the distribution of blood supply and biliary drainage. The left liver is comprised of segments II, III, and IV, while the right liver is comprised of segments V, VI, VII, and VIII. Segment I is the caudate lobe. These lobules are connected to small ducts (tubes) that connect with larger ducts to form the common hepatic duct. The common hepatic duct transports the bile made by the liver cells to the gallbladder and duodenum (the first part of the small intestine) via the common bile duct.
What is liver cancer surgery?
Liver cancer surgery is performed to remove the portion of liver with the cancer. Liver cancer surgery can be anatomical or non-anatomical, depends on the type and location of cancer.
Anatomical resection is carried out along the functional segments of the liver. Examples are
Left lateral sectionectomy– resection of segment II-III
Right hepatectomy - resection of segments V-VIII
Left hepatectomy - resection of segments II-IV.
Non-anatomical resection is performed to with a margin of at least 1cm without regard to segmental, sectional of lobar anatomy. This is often performed for tumours located in the peripheral part of liver.
Each type of resection has its own indications. Please discuss with your surgeon regarding the type of liver resection that is required for your condition.
What is involved in liver surgery for cancer?
Liver surgery can be performed open or laparoscopic. This is performed under general anaesthesia. You might require a central venous access during the surgery for haemodynamic monitoring and blood transfusion if needed.
Laparoscopic liver resection is considered most appropriate for small (<5 cm), solitary lesions located in peripheral segments of the liver, when performed by experienced surgeon.
Open surgery is often reserved for larger tumours when major liver resection (>3 segments) is required.
What happens when you are diagnosed with liver cancer?
Each cancer requires a specific work-up. Work-up includes blood tests (e.g. full blood count, liver function test, coagulation profile, renal function, tumour markers), imaging (ultrasound, CT, MRI liver and/or PET scan) or biopsy.
After the work-up, your case will be discussed in a multi-disciplinary meeting which includes your surgeon, medical oncologist, radiation oncologist, hepatologists and interventional radiologist to discuss the specific type of treatments and treatment sequence.
The treatments include:
Surgery
Ablation
Systemic chemotherapy
Trans-arterial chemo-embolisation (TACE)
Selective internal radiation therapy (SIRT)
Stereotactic Body Radiation Therapy (SBRT)
Possible risks
Liver resection is a major, serious operation that should only be done by skilled and experienced surgeons. Because people with liver cancer usually have other liver problems besides the cancer, surgeons have to remove enough of the liver to try to get all of the cancer, but also leave enough behind for the liver to function.
Bleeding: A lot of blood passes through the liver, and bleeding after surgery is a major concern. Also, the liver normally makes substances that help the blood clot. Damage to the liver (both before the surgery and during the surgery) can add to potential bleeding problems.
Bile leak
Liver failure
Infection
Complications from anaesthesia
Blood clots
Pneumonia
New liver cancer: Because the remaining liver still has the underlying disease that led to the cancer, sometimes a new liver cancer can develop afterward.
What is the recovery from liver surgery?
Recovery after liver surgery depends on various factors e.g laparoscopic vs open, extent of liver resection (minor vs major), blood loss, or any complications that may arise from the surgery. This can range from 3 days (for straight forward laparoscopic procedure) to 1-2 weeks (for open major liver resection).
After the surgery, you might require a short stint in intensive care unit for close monitoring. You will be stepped down to the ward after 1-2 days. You are encouraged to mobilise, and diet will be introduced as early as possible.
