Liver Cancer: Surgery
Surgery offers the best chance to cure liver cancer. But only a small portion of people with liver cancer can have surgery. Different kinds of surgery may be done. Which type you have depends on the size of the cancer, where it is, how much it has spread, how well the rest of your liver is working, and other factors.
When might surgery be used for liver cancer?
Surgery is often the treatment of choice if it can be done. But surgery may not be a choice if you have cirrhosis or other liver problems and don’t have enough healthy liver. Surgery is not a choice if the cancer has spread outside the liver to other parts of the body. You might be a candidate for surgery if:
Your cancer is in only one part of the liver and is not in a major blood vessel. The rest of your liver must be fairly healthy, and you must be otherwise healthy enough to have major surgery. In this case, you might be able to have surgery to remove the part of the liver containing the tumor. This is called a hepatectomy.
Your cancer is only in the liver, but it is too large or in too many places. Or the rest of your liver is not healthy enough for a hepatectomy. You may be able to have surgery to remove the entire liver, followed by a liver transplant.
Types of surgery for liver cancer
Below are options for liver cancer surgery.
Hepatectomy (partial hepatectomy or tumor resection)
The surgeon removes the part of the liver that contains the tumor. It is often the preferred surgery if it can be done. But not many people with liver cancer can have this surgery. This is because the cancer has grown too large or is in many parts of the liver, or because the rest of the liver isn't healthy enough for the person to withstand surgery. The surgeon usually will use a long cut (incision). But some doctors now do it laparoscopically. In this approach, the surgeon makes several small incisions in the abdomen. He or she uses long, thin surgical tools to remove part of the liver. One of these tools (laparoscope) has a tiny video camera on the end to let the surgeon see inside the abdomen.
The surgeon removes the entire liver and replaces it with part or all of a liver from a donor. More people might be able to have this type of surgery, but its use is limited because it can be hard to find a donor liver for transplant.
Possible risks, complications, and side effects of surgery
Surgery for liver cancer is a major operation, so it's important that you are healthy enough for it and that the doctor thinks the possible benefits outweigh the risks. All surgery has risks. Some of the risks of any major surgery include:
Reactions to anesthesia
Blood clots in the legs or lungs
Damage to nearby organs
Other risks from liver surgery
Along with the risks above, liver surgery can sometimes cause these problems:
Excess bleeding. Bleeding is a risk with any type of surgery, but this risk can be even higher with liver surgery. This is because a lot of blood passes through the liver. The liver also makes clotting factors that normally help stop bleeding, and surgery can also affect this.
Infection. This is especially a concern in people who get a liver transplant. This is because they need to take medicines to suppress their immune system to keep it from rejecting the donor liver. Infections in people taking these medicines can be very serious. The medicines themselves can also have their own side effects.
Rejection of the donor liver. Even though people who have had a liver transplant take medicines to suppress their immune system, sometimes the body might still reject the new liver.
Getting ready for your surgery
Before you go for surgery, you will meet with your surgeon to talk about the procedure. At this time, you can ask any questions and discuss any concerns you may have. This is also a good time to review the possible side effects of the surgery and to talk about its risks. You might ask if the surgery will leave scars and what those scars will look like. You might also want to ask when you can expect to return to your normal activities. After you have discussed all the details with the surgeon, you will sign a consent form that says that the doctor can do the surgery.
You may be told to stop taking certain medicines a few days before the surgery. You may also be told to follow a special diet.
What to expect during surgery
When it is time for your surgery, you will be taken into the operating room. Medical staff will place an IV (intravenous) line in your arm. Medical staff will watch your heart rate, blood pressure, breathing, and other vital signs during the surgery. You will be given medicine to make you sleep through the surgery so you will not feel any pain.
What your surgeon removes and where he or she makes the incisions depends on the type of surgery you have. And that is based on where the tumor is.
After your surgery is complete, medical staff will move you to the recovery room. Staff will monitor you for another hour or two. Once you are awake and stabilized, the staff will move you to the regular hospital floor.
What to expect after surgery
When you first wake up, you might have some pain. Your doctor or nurse will give you pain medicine as needed for a few days to help you feel more comfortable. The pain medicine will also help you get up and walk the day after your surgery. Walking is important for your recovery.
It will take you time to get back to eating normally and having regular bowel movements. You may have to stay in the hospital for at least several days. How long you stay will depend on the type of surgery you have. People who have a laparoscopic hepatectomy can often go home sooner than those who have an open hepatectomy. This is because they have smaller incisions that can usually heal faster.
You can gradually return to most normal activities once you leave the hospital. But you should avoid lifting heavy things for several weeks. Always follow the instructions you get from your doctor or nurse.
After surgery, you may feel weak or tired for a while. The amount of time it takes to recover from an operation is different for each person. But you will probably not feel like yourself for several months. You likely won't be able to drive for a while, as directed by your healthcare providers.
March 21, 2017
Liver transplantation for hepatocellular carcinoma. UpToDate., Surgical management of potentially resectable hepatocellular carcinoma. UpToDate.
Alteri, Rick, MD,LoCicero, Richard, MD