The aim of a liver resection is to remove all cancer from the liver, as well as a margin of healthy tissue. Liver resection is usually performed in a specialist treatment centre.
Learn more about:
- Types of liver resection
- Portal vein embolisation (PVE)
- How a liver resection is done
- What type of surgery will I have?
- What to expect after the surgery
- How a portal vein embolisation (PVE) is done
- Video: Treating liver cancer with surgery
A liver resection is suitable for only a small number of people with liver cancer. The liver needs to repair itself after the surgery, so a resection is only an option when the liver is working well.
People with no or early cirrhosis may be considered for surgery, but it is unlikely that people with more advanced cirrhosis will be offered surgery. Surgery is also not suitable for people with ascites or when the cancer has spread to major blood vessels.
Before your treatment begins, your treatment team may suggest that you exercise, eat a healthy diet, or speak to a counsellor about how you feel. If you smoke, you will be encouraged to stop. Research shows that quitting smoking before surgery reduces the chance of complications. Preparing for treatment in this way – called “prehabilitation” – may help your recovery.
Types of liver resection
The surgeon will consider the size and position of the tumour, as well as the health of the liver, to work out how much of the liver can be safely removed. The liver resection may be called a right or left hepatectomy (removes the right or left part of the liver) or a segmentectomy (removes a small section of the liver). In some cases, the gall bladder may also be removed, along with part of the muscle that separates the chest from the abdomen (the diaphragm).
Portal vein embolisation (PVE)
Sometimes, the surgeon needs to remove so much of the liver that the remaining portion may not be large enough to recover. In this case, you may have a portal vein embolisation (PVE) about 4–8 weeks before the liver resection.
A PVE is performed by an interventional radiologist and is normally done under local anaesthetic.
How a liver resection is done
If you have a liver resection, it will be carried out under a general anaesthetic. There are two ways to perform the surgery:
- in open surgery, the surgeon makes a large cut in the upper abdomen under the rib cage. This is the most common type of surgery.
- in keyhole (laparoscopic) surgery, the surgeon makes a few small cuts in the abdomen, then inserts a thin instrument with a light and camera (laparoscope) into one of the cuts. Using images from the camera as a guide, the surgeon inserts tools into the other cuts to remove the cancerous tissue.
What type of surgery will I have?
People who have laparoscopic surgery usually have a shorter stay in hospital, less pain and a faster recovery time. However, laparoscopic surgery is not suitable for everyone with primary liver cancer and it is not available in all hospitals. Both open surgery and laparoscopic surgery are major operations – talk to your surgeon about the best option for you.
What to expect after the surgery
The portion of the liver that remains after the resection will start to grow, even if up to two-thirds of the liver has been removed. It will usually regrow to its normal size within a few months, although its shape may be slightly changed. After surgery:
- bleeding is a risk because a lot of blood passes through the liver – you will be monitored 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 or intensive care unit before moving to a standard room.
Learn more about recovering after surgery.
Video: Treating liver cancer with surgery
Dr Vincent Lam talks about how surgery is used to treat liver cancer.
Podcast: Making Treatment Decisions
A/Prof Simone Strasser, Hepatologist, AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital and The University of Sydney, NSW; A/Prof Siddhartha Baxi, Radiation Oncologist and Medical Director, GenesisCare, Gold Coast, QLD; Prof Katherine Clark, Clinical Director of Palliative Care, NSLHD Supportive and Palliative Care Network, Northern Sydney Cancer Centre, Royal North Shore Hospital, NSW; Anne Dowling, Hepatoma Clinical Nurse Consultant and Liver Transplant Coordinator, Austin Health, VIC; A/Prof Koroush Haghighi, Liver, Pancreas and Upper Gastrointestinal Surgeon, Prince of Wales and St Vincent’s Hospitals, NSW; Karen Hall, 131120 Consultant, Cancer Council SA; Dr Brett Knowles, Hepato-Pancreato-Biliary and General Surgeon, Royal Melbourne Hospital, Peter MacCallum Cancer Centre and St Vincent’s Hospital, VIC; Lina Sharma, Consumer; David Thomas, Consumer; Clinical A/Prof Michael Wallace, Department of Hepatology and Western Australian Liver Transplant Service, Sir Charles Gairdner Hospital Medical School, The University of Western Australia, WA; Prof Desmond Yip, Clinical Director, Department of Medical Oncology, The Canberra Hospital, ACT.
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