Liver Resection (Cancer)
Liver Resection (Cancer)
Liver Resection (also known as a Hepatectomy) is a major surgical procedure to remove malignant tumours from the liver. Because the liver is the only internal organ capable of regeneration, surgeons can safely remove a large portion of it, and the remaining healthy tissue will grow back to nearly its original size within 6 to 10 weeks. This remains the "gold standard" for curative intent when cancer is confined to the liver.
When You Should Consider Liver Resection
Hepatocellular Carcinoma (HCC): The most common primary liver cancer, particularly in patients with a history of hepatitis or cirrhosis.
Intrahepatic Cholangiocarcinoma: When cancer originates in the bile ducts located within the liver tissue.
Metastatic Colorectal Cancer: If colorectal cancer has spread only to the liver, a resection can still be a curative pathway.
Clear Margins: When imaging confirms the tumour can be removed while leaving a healthy "rim" of tissue behind.
Solitary or Limited Tumours: When the malignancy is confined to specific segments that allow for a safe "Future Liver Remnant."
Surgical Techniques
Anatomic Resection: Removing a specific functional segment or lobe (the liver has 8 segments) along with its dedicated blood supply and bile duct.
Non-Anatomic (Wedge) Resection: Removing the tumour plus a 1-cm "rim" of healthy tissue; typically used for small tumours near the surface.
Open Surgery: Performed via a "Mercedes-Benz" or "J-shaped" incision; used for large or centrally located tumours.
Laparoscopic/Robotic Surgery: Performed through several 1-cm punctures. This 2026 standard offers faster recovery and less pain for suitable tumour locations.
Two-Stage Hepatectomy: In complex cases, surgeons may remove tumours from one side, allow it to regenerate, and then remove the rest in a second surgery.
How Liver Resection Is Performed
Anaesthesia: The procedure typically takes 3 to 7 hours under general anaesthesia.
Intraoperative Ultrasound: Surgeons use a specialized probe directly on the liver during surgery to find hidden tumours and map blood vessels.
Transection: The liver tissue is carefully divided using advanced tools (like ultrasonic aspirators) that seal blood vessels and bile ducts as they cut.
Pringle Manoeuvre: A technique used to temporarily "clamp" blood flow to the liver to prevent heavy bleeding during the removal phase.
Drain Placement: Small tubes may be left in the abdomen to monitor for any bile leaks or fluid buildup during the first few days of recovery.
Pre-Surgery Preparation
Future Liver Remnant (FLR) Assessment: Ensuring that the amount of healthy liver left after surgery (at least 25–30% for healthy livers) is sufficient for survival.
Portal Vein Embolization (PVE): If the planned remnant is too small, a procedure is done weeks prior to "trick" the healthy side into growing larger before the operation.
Nutritional Optimization: Following a specific diet to reduce liver fat (steatosis), which improves the organ's ability to regenerate.
Cardiovascular Clearance: Undergoing a stress test to ensure the heart can handle the circulatory shifts that occur during liver surgery.
Medication Audit: Strictly stopping all blood-thinners and certain herbal supplements at least one week before the procedure.
Pre-Surgery Tests
Tri-Phasic CT or MRI: To visualize the liver's blood supply and precisely locate tumours in relation to the eight segments.
Indocyanine Green (ICG) Clearance: A specialized test to measure how well the liver filters dye, predicting its post-operative function.
AFP (Alpha-fetoprotein) Test: A blood marker used to establish a baseline for monitoring primary liver cancer.
FibroScan: To assess the degree of underlying scarring (cirrhosis), which dictates how much liver can safely be removed.
PET-CT Scan: To ensure there is no hidden cancer outside the liver that would make surgery ineffective.
Life After Liver Resection (Recovery & Risks)
Regeneration Timeline: The most intense growth happens in the first 14 days, with the liver returning to nearly full size within 2 months.
Haemorrhage Risk: Because the liver is highly vascular, significant bleeding is the primary risk during the surgery and the immediate recovery phase.
Bile Leak: A 5–10% risk where bile leaks from the cut surface; most are managed with temporary plastic drains.
Post-Hepatectomy Liver Failure (PHLF): A serious risk if the remaining liver is too small or weak to filter toxins and produce clotting factors.
Pleural Effusion: Fluid buildup around the right lung is common after right-sided surgery and is monitored closely in the hospital.
Why Specialized Treatment Is Highly Effective
Unique Regenerative Power: The liver’s ability to grow back allows for the removal of up to 75% of the organ while maintaining life.
Curative Intent: For colorectal metastases, the 5-year survival rate after a successful resection is approximately 40–60%.
2026 Robotic Precision: Minimally invasive techniques have significantly reduced the "Mercedes-Benz" scar and shortened hospital stays to 5 days.
PVE Advancements: Portal Vein Embolization now allows patients who were previously "inoperable" to become candidates for surgery.
Multidisciplinary Success: When paired with modern chemotherapy, resection offers the best long-term outlook for primary and metastatic liver cancers.
