What is a liver resection?
Liver resection is the surgical removal of part of the liver. It can often be done either by open surgery or laparoscopically (“keyhole surgery”).
When is a liver resection required?
The most common reason for performing a liver resection is for cancer or other tumours of the liver. Not all cancers and malignant tumours can be removed surgically. Depending on the number of tumours, their size and their location as well as the patient’s liver function, the surgeon can determine whether or not a tumour should be removed or not. Spread to other organs is also an important consideration.
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How does one determine how much liver to remove?
The amount of liver which has to be removed depends on the characteristics of the tumour and the function of the patient’s liver. It can vary from a small section of liver (“wedge resection”) to half the liver (“hemihepatectomy”) to greater than half of the liver (“extended resection”). Obviously, each of these operations have different implications on complications and recovery.
The key investigation in planning for surgery is a CT or MRI scan with intravenous contrast (dye injected into the vein). These scans allow the surgeon to determine the exact location of the tumours and its position in relation to major blood vessels and bile ducts within and outside of the liver. It can also be used to calculate the volume of liver tissue which will be left after the operation, thereby reducing the risk of inadvertently removing too much liver. Blood tests to assess the liver function would also be performed.
Caption: these are examples of liver resection. If the tumour is in the right half of the liver, the right half of the liver may be removed (right hepatectomy). If there are multiple spots, one may remove these parts separately provided it is safe to do so.
Is it possible to grow the liver before surgery to allow for safe removal of large parts of the liver?
Sometimes if the anticipated amount of liver that will remain after surgery is not large enough, the surgeon may refer the patient for a procedure called “Portal Vein Embolisation”. This procedure is performed by a radiologist (x-ray specialist). In this procedure some of the blood vessels supplying the part of the liver planned for removal is blocked off by injecting material into it. This will make that part of the liver shrink and consequently the remainder of the liver grow. Often but not always, this will “grow” the liver enough to allow for removal of the tumour.
What are the risks of surgery?
Like any operation, there are risks. As these operations are all major operations, the risks are very significant.
Firstly, there are risks associated with the anaesthetics – this is related to the patient’s age and medical issues. In general, due to the nature of the surgery, the patient will be booked in for the preadmissions clinic where the patient will see the anaesthetist to have these risks assessed and fully explained. To help manage these risks, patients are generally transferred to the High Dependency Unit or Intensive Care Unit for the first few days after the operation for intensive monitoring.
With regards to surgical risks, specific risks of surgery include:
- Bleeding – the liver is an organ with lots of small blood vessels within it. A possible complication of liver surgery is therefore major bleeding. Sometimes this may require reoperation.
- Bile leak – The liver has many small bile ducts coursing throughout. Cutting into the liver may result in leakage of bile from the cut surface of the liver. This leakage may stop by itself although sometimes an endoscopy may have to be performed to decompress the bile duct to stop the leak. Very rarely, a repeat operation to correct the problem may be required.
- Liver failure – If too much liver is removed during the operation, there might not be enough liver left for the usual functioning of the liver. This might lead to liver failure.
- Damage to surrounding structures, especially bile ducts, blood vessels and bowel.
- Death – There is a small chance of dying during or shortly after surgery. This may be related to bleeding, infection or liver failure. The risks of this, even with major liver surgery should be less than 1 in 20.
- Other general complications of major surgery such as wound or deep infections, clots in the legs of lungs, urinary or chest infections, adhesions (scarring inside) and hernias may occur also.
I am having surgery for the liver, do you have any further information regarding this operation?
Yes. We have created an information sheet for our patients undergoing liver resection. Do note that this is generic information and may not apply specifically to your circumstance.
If you are undergoing surgery with us at CESA, our surgeons will explain everything to you in detail with information which is tailored to your specific circumstances. Also, feel free to ask your surgeon any questions which may not be covered in the information sheet.