Liver surgery is most commonly indicated for resection or removal of liver cancer. It may be done laparoscopically (key hole surgery) or by conventional open surgery, depending on the site of the tumour. In Australia, the most common indication is the removal of metastases (secondaries or spread) of bowel cancer. Patients with this condition will often have other treatments such as chemotherapy or radiological procedures as part of the treatment plan.
The next most common indication is hepatocellular cancer (hepatoma, HCC), which is often associated with chronic liver disease such as hepatitis or haemochromatosis.
Occasionally, other tumours of the liver such as cholangiocarcinoma (cancer of the bile duct), gallbladder cancer, and secondaries from neuroendocrine cancers and melanoma are appropriate for surgical treatment.
There are a number of benign tumours of the liver, most of which can be monitored and do not need to be removed. Up to 70 per cent of a healthy liver can be removed as it will regenerate. In patients with chronic liver disease less can be safely removed.
Liver surgery includes various surgical procedures performed on the liver, for the management of different diseases affecting the liver. Resection is the most common surgical procedure performed on the liver and comprises of the removal of a portion of the liver. A malignant tumour is the most common indication for a liver resection.
Based on the origin, tumours in the liver are categorized into:
- Primary tumours: They develop within the liver.
- Metastatic tumours: They develop in some other organ and migrate to the liver, through the bloodstream.
Colon cancer is the most common cause of metastasis to the liver. Single or multiple tumours involving the different lobes of the liver can be resected with a high success rate, depending on the stage of the primary tumour.
Liver resection may also be employed for benign tumours of the liver such as cyst, adenoma, and haemangioma. For small and superficially located benign tumours a laparoscopic approach can be employed for the resection. Liver resection can also be performed as a part of live donor liver transplant in individuals who voluntarily donate a part of their liver to their relatives.
Liver resection does not require blood transfusion and requires about 3-5 hours. Up to 75% of the liver tissues can be securely removed by a liver resection. The patients may be required to stay in the hospital for about 5 days after the procedure. Liver is capable of regeneration. The complete regeneration of the resected liver, to its original size, may take 6-8 weeks. Good nutrition with a high protein diet is crucial for liver regeneration. However, cirrhotic liver or unhealthy liver is not capable of regeneration.
Patients undergoing liver surgery should be screened for various liver diseases that can affect the outcome of the surgery. Liver surgery is contraindicated in the following conditions:
- Acute or fulminant hepatitis
- Alcoholic hepatitis
- Severe chronic hepatitis
Other conditions associated with a variable risk following a liver surgery include obstructive jaundice, cardiac surgery, and trauma.
Risks and complications
The common complications associated with liver surgery include:
- Liver failure
- Liver abscess
- Infection around the surgical site
- Blood clots
- Bile leakage
Some of the basic post-operative instructions for patients undergoing liver surgery are as follows:
- The dressing over the incision is usually removed 2-3 days after the surgery.
- Regular intake of the prescribed medications is necessary for best outcome.
- Walk and perform some physical activities to keep the lungs healthy and prevent blood clots.
- Avoid all consumption of alcohol.
- Do not eat or drink anything for the first few days after the surgery.
- Patients may gradually start on a liquid diet followed by solid foods, few weeks after the surgery.
Avoid lifting heavy weights for at least 6-8 weeks.