Surgery for secondary liver cancer
The aim of surgery is to remove the part of the liver that contains cancer. This is known as liver resection or partial hepatectomy. It can be an effective treatment, but it is only possible if there is enough healthy liver and the cancer hasn’t spread to other parts of the body where it can’t be removed (such as the bones). Some people need surgery for both the secondary cancer in the liver and the primary cancer. These operations may be done separately or at the same time.
A liver resection is a major operation. You will have a general anaesthetic and the surgeon will remove the tumour as well as some healthy-looking tissue around it. The operation may be done as open surgery (with one large cut) or as keyhole or laparoscopic surgery (with several smaller cuts).
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Types of liver resections
Depending on the cancer’s size and position, the liver resection may be called a right or left hepatectomy (removes the right or left part of the liver), extended right or left hepatectomy (removes most of the liver), or segmentectomy (removes a small section of the liver). Sometimes the gall bladder may also be removed, along with part of the muscle that separates the chest from the abdomen (the diaphragm).
After the surgery
The liver can repair itself easily if it is not damaged already. The part of the liver that remains after resection will start to grow, even if up to three-quarters of it is removed. The liver will usually regrow to its normal size within a few months, although its shape may be slightly changed. When a very large amount of the liver needs to be removed, you may need a procedure called a portal vein embolisation (PVE) 4–8 weeks before the surgery.
- bleeding is a risk because a lot of blood passes through the liver – your medical team will monitor you for signs of bleeding and infection
- some people experience jaundice (yellowing of the skin and whites of the eyes) – this is usually temporary and improves as the liver grows back
- most people will need a high level of care – you will spend 5–10 days in hospital after a liver resection and it is common to spend some time in the high dependency unit or intensive care unit before moving to a standard room.
For more on this, see our general section on Surgery.
People with tumours in both lobes of the liver sometimes need surgery that is carried out in two stages with a waiting period between them.
|stage 1||The tumours are removed from one lobe of the liver (partial hepatectomy). Sometimes this surgery is combined with tumour ablation or removal of the original cancer.|
|waiting period||After the first surgery, you will need to wait 1–2 months to allow your body to recover and the liver to regrow. You may have a portal vein embolisation during this time to improve the part of the liver that will remain after stage 2. Before you have the second operation, you will have a CT scan to check the size of your liver.|
|stage 2||If enough of the liver has regrown, you will have another partial hepatectomy to remove the tumours in the second lobe of the liver.|
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Dr David Yeo, Hepatobiliary/Transplant Surgeon, Royal Prince Alfred, Chris O’Brien Lifehouse Cancer Centre and St George Hospitals, NSW; Dr Lorraine Chantrill, Head of Department Medical Oncology, Illawarra Shoalhaven Local Health District, NSW; Michael Coulson, Consumer; Dr Sam Davis, Interventional Radiologist, Staff Specialist, Royal Brisbane and Women‘s Hospital, QLD; Prof Chris Karapetis, Network Clinical Director (Cancer Services), Southern Adelaide Local Health Network, Head, Department of Medical Oncology, Flinders Medical Centre and Flinders University, SA; Dr Howard Liu, Radiation Oncologist, Princess Alexandra Hospital, QLD; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Lina Sharma, Consumer; Dr Graham Starkey, Hepato-Biliary and General Surgeon, Austin Hospital, VIC; Catherine Trevaskis, Gastrointestinal Cancer Specialist Nurse, Canberra Hospital and Health Services, ACT; Dr Michael Wallace, Western Australia Liver Transplant Service, Sir Charles Gairdner Hospital, WA.
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