Liver surgery / hepatectomy is sometimes necessary to remove a portion of the liver affected by tumours, lesions, or other conditions.
The goal of the surgery is to remove the affected part of the liver whilst preserving as much healthy liver as possible.
Depending on the underlying health of the liver, up to 80% of the liver can be removed safely since the remaining liver can regenerate.
Liver surgery can also be combined with other techniques such as liver ablation and if initial planning suggests that not enough healthy liver is able to be left behind, then there are several techniques that can be used to facilitate safe liver resection (e.g. portal vein embolization, two-stage hepatectomy)
Procedure
During liver surgery, the patient is placed under general anaesthesia. The surgeon makes an incision in the abdomen to access the liver (see below for details on laparoscopic/robotic liver surgery).
The affected part of the liver, along with a margin of healthy tissue, is carefully removed.
The remaining parts of the liver are then confirmed to have continued blood flow and function. Some types of liver resection also require specific reconstruction of the bile ducts and blood vessels to ensure function.
Types of Liver Surgery
Different types of liver resection procedures may be performed based on the location and extent of the liver condition.
These include:
- Wedge resection: Removal of a small, wedge-shaped portion of the liver
- Segmental resection: Removal of an entire section of the liver
- Lobectomy: Removal of an entire lobe of the liver
Laparoscopic/ Robotic Liver Surgery
The traditional approach to liver resection has required an open cut in the upper part of the abdomen. However, in expert hands, many liver resections can be done either laparoscopically or robotically via small (8mm-12mm) incisions.
This allows precise surgery with decreased blood loss, a lower risk of complications and decreased hospital length of stay. Most patients also find that they can return to regular activities sooner. Laparoscopic or robotic resection may not be suitable in all patients with the appropriate surgical approach decided upon on a bespoke basis in a multidisciplinary setting.
Risks and Complications
Liver resection is major surgery and carries certain risks and potential complications, including:
- Death (This risk is very low)
- Need for urgent procedures after surgery
- Bleeding
- Infection
- Bile leakage
- Liver failure
- Medical problems from the stress of surgery such as heart attack, pneumonia, blood clots
The risks of surgery and how they apply to each patient are usually discussed during any consultation when surgery is planned and again when consent for surgery is obtained.
Recovery after liver surgery
After surgery, the patient is closely monitored in the hospital for several days to ensure proper healing and to watch for any signs of complications. Pain management, intravenous fluids, and antibiotics may be administered as needed. Most patients can eat relatively quickly after surgery (within about 48 hours).
After being discharged from hospital, patients can require a further period of convalescence. Studies indicate that the liver regenerates a significant amount in the first six weeks after surgery.
During this period, patients can experience a sense of fatigue that is hard to describe. Patients are not confined to bed-rest nor incapacitated but might require more rest than usual (e.g. an afternoon nap) or be able to do less when tasks are physically demanding (e.g. mowing lawns).
Follow-Up Care
Regular follow-up visits with a healthcare provider are crucial for individuals who have undergone liver resection. These visits are essential to monitor the recovery process, assess liver function, and detect any signs of cancer recurrence (if appropriate) or complications.
Depending on the specific condition, additional treatments such as chemotherapy may be required following surgery.