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Surgical Resection

Watch this video to listen to Benjamin Samstein, M.D., the Surgical Director at the Living Donor Liver Transplant Program and an Attending Surgeon at NewYork-Presbyterian Hospital/Columbia University Medical Center discuss surgery for liver cancer:

 

Surgical removal of a liver tumor has the potential to cure patients, but only in situations in which the tumor has not already spread to other sites. Patients with hepatocellular carcinoma commonly have underlying liver cirrhosis. The presence of cirrhosis creates challenges for successful surgery for several reasons. While normal liver can “regenerate” after a portion of it has been removed, cirrhotic livers do not regenerate as well, or in some cases, at all. Therefore, only limited amounts of liver may be removed from individuals with cirrhosis.

In addition, some patients with cirrhosis have elevated blood pressures within the liver, known as portal hypertension. This can lead to excessive bleeding during surgery. Livers with more advanced cirrhosis do not make blood clotting factors as well normal livers, and a shortage of clotting factors in the bloodstream can result in serious and life-threatening post-operative bleeding. Careful testing and assessment by an experienced liver surgeon are necessary to determine whether or not a liver tumor can be surgically removed.
 
Patients with multiple tumors or tumors that invade into major blood vessels such as the portal veins are not suitable candidates for surgery. The location of a liver tumor must be such that resection of the tumor allows for leaving behind sufficient normal liver.
 
A biopsy of the liver tumor using a needle placed through the abdominal wall under CT guidance is sometimes, but not always recommended. In some cases, a surgeon will choose a strategy in which the blood supply to one side of the liver is blocked off many weeks prior to surgery, (PVE, portal vein embolization) to stimulate growth (liver regeneration) on the other side of the liver prior to resection. The portal vein embolization does not require an operation, and is performed by a specially trained radiologist.
 
 
Liver resections are generally technically complex operations, and should be performed by a surgeon that has specialized training in this field. Liver resections generally take several hours, and most patients are hospitalized for 5 - 10 days, and in some cases, much longer. In rare instances, a liver tumor can be removed by laparoscopic surgery, in which instruments are placed through the abdominal wall to avoid a large incision.
 
Surgical removal of a liver tumor has the potential to cure patients, but only in situations in which the tumor has not already spread to other sites. Unfortunately, there is not any type of test that can ensure the absence of tumor spread to other sites, except for the test of time. After recovery from a liver resection, patients will undergo surveillance scans at regular intervals to look for evidence of tumor spread.
 
Hepatic resection is the surgical removal of a portion of the liver. It is reserved for patients with relatively normal livers or mild cirrhosis. Patients with more advanced cirrhosis are at a greater risk for complications and may not be healthy enough for surgery. Postoperative complications can occur when a large part of the liver is removed or when the liver is severely damaged by cirrhosis. Complications include infection, fluid retention in the abdominal cavity, swelling, jaundice (yellowing of the skin) and liver failure.
 
Overall, patient survival after hepatic resection is estimated to be 54% at 5 years. Unfortunately, there is not any type of test that can ensure the absence of tumor spread to other sites, except for the test of time. After recovery from a liver resection, patients will undergo surveillance scans at regular intervals to look for evidence of tumor recurrence.
 

Last Updated on 4/16/2012 2:41:47 PM