What is a liver resection?
A liver resection is a surgical procedure to remove a part of the liver that has been affected by cancer. The aim is to completely remove any tumour and a small margin of healthy tissue around where the tumour was. It may also be referred to as a 'partial hepatectomy' or 'hepatic resection'.
In most cases it is performed to treat secondary liver cancer, that is where cancer cells have travelled to the liver (via the bloodstream) from a tumour elsewhere in the body and formed a tumour in the liver.
What are the symptoms of liver cancer?
The following are common symptoms of liver cancer:
- Abdominal swelling – this is due to a condition called ascites where there is fluid buildup in the abdominal cavity.
- Fatigue / weakness.
- Pain – especially where this is on the right side of the upper abdomen or close to the shoulder blade on the right-hand side of the body.
- Weight loss (where otherwise unexplained).
- Yellowing of the skin and eyes – a condition called jaundice.
How should I prepare for the procedure?
Medication / supplements
You need make the surgical team aware of any medication (including alternative / complementary medicines) or diet supplements you are taking before the procedure.
If you are a smoker, you must give up smoking 14-21 days before the procedure.
You do not need to make any changes to your diet ahead of surgery.
Staying fit and healthy
Patients undergoing this type of surgery experience better outcomes if they are fit and healthy immediately prior to the procedure, so you should continue any regular exercise as normal before the procedure. We recommend you do not take up any new exercise regime without first consulting your doctor or Dr Silverman.
Avoiding wound infection
You should avoid waxing or shaving in the area where incisions are likely to be made during surgery (your doctor or surgeon will be able to tell you where the incisions will be made). This minimises the risk of wound infection.
There are no specific hygiene requirements before surgery, however you should have a shower or take a bath either the night before or on the morning of the surgery.
What is involved in the procedure?
The procedure may be performed using laparoscopic surgery or conventional open surgery. Most patients will undergo open surgery, as laparoscopic techniques can only be used for certain resections (based on the location and size of the tumour). Around one in seven patients are able to be operated on laparoscopically for this procedure.
Open surgery approach
Open surgery involves a larger incision just under the ribs. The procedure is carried out under general anaesthesia and normally takes 4-5 hours to complete. Ultrasound is often used to find any cancer cells or cancer growth (tumour). These cells are then removed along with a 'margin' of normal tissue, tha is a small quantity of healthy tissue around the section containing the cancer cells. Once all necessary sections of the liver have been removed, the incision is closed.
In some cases, fluid may be likely to build up in the abdominal cavity after the procedure. If Dr Silverman determines this is likely, a drain is inserted into the abdominal cavity to make sure it does not collect there.
Laparoscopic surgery approach
This surgery is carried out under general anaesthesia and can take between one and seven hours depending on the size and location of the tumour (Dr Silverman will be able to give you a better idea of the likely duration of your specific procedure).
Instead of one large incision, a number of much smaller incisions are made to the abdomen to allow the laparoscopic surgical instruments access to the abdominal cavity.
Exactly the same process as described in the 'open surgery approach' above is then followed. Around one in twenty laparoscopic liver resection procedures need to be converted to open surgery. If this is the case, the smaller incisions are closed and the larger incision is made as per open surgery.
A liver resection involves extensive surgery and for this reason it is normal for a patient to stay in hospital for one to two weeks where the procedure was carried out using open surgery, and 2-5 days where the procedure was laparoscopic. The first one or two days after surgery will be spent in intensive care.
Normal bodily functions such as bowel movements generally do not restart for a few days and so all nutrients will be delivered via a drip during this time.
Returning to normal activities
It can take up to three months to fully recover from this procedure. In the first 2-4 weeks after surgery it is normal to experience a high level of fatigue and to have a reduced appetite. You may also feel generally low during this period. The recommended approach to activity during this period is to introduce light activities, such as walking and to start with short periods and distances and build these up gradually.
Other more demanding activities such as driving or more physical exertion will also need to be introduced gradually – your doctor or Dr Silverman will be able to give you some guidance as to when you can resume these activities.
When to contact Dr Silverman
If you experience any of the following you must contact Dr Silverman immediately:
- Abdominal swelling.
- Pain in the chest area.
- Pain in the upper back.
- Loss of appetite (particularly if this continues beyond the first 48-hours after surgery).
- Nausea (particularly if this continues beyond the first 48-hours after surgery).
- High temperature.
- Feeling faint.
- No bowel motion.
- Problems urinating.
Risks / complications
There are risks associated with all surgical procedures (especially complex surgery such as liver resection) such as wound infection, and risks relating to anaesthesia and bleeding during the procedure.
The risks/complications specific to liver resection include:
- Bleeding is a particular risk associated with liver resection, due to the liver's involvement in processing blood and clotting agents.
- Possible recurrence of liver cancer.
Dr Silverman will be able to discuss any possible risks or complications with you well ahead of the procedure.