Liver Surgery

Liver resection is the surgical removal of a portion of the liver. This operation is usually done to remove various types of liver tumors that are located in the resected portion of the liver. The goal of liver resection is to completely remove the tumor and the appropriate surrounding liver tissue without leaving any tumor behind.

n patients with liver cancer (Hepatocellular Cancer, HCC), liver resection is limited to patients with one or two small (5 cm or less) tumors confined to the liver with no invasion of the blood vessels. As a result of these strict guidelines, in practice, very few patients with HCC can undergo liver resection. The biggest concern about resection is that following the operation, the patient can develop liver failure. The liver failure can occur if the remaining portion of the liver is inadequate (for example, because of associated cirrhosis) to provide the necessary support for life.

The goal of liver resection is to completely remove the tumor and the appropriate surrounding liver tissue without leaving any tumor behind. This option is limited to patients with one or two small (3 cm or less) tumors and excellent liver function, ideally without associated cirrhosis. As a result of these strict guidelines, in practice, very few patients with liver cancer can undergo liver resection. The biggest concern about resection is that following the operation, the patient can develop liver failure.

For HCC patients whose tumors are successfully resected, the five-year survival is about 10% to 60%, depending on the tumor size. This means that 10% to 60 % of patients who actually undergo liver resection for liver cancer are expected to live five years. Many of these patients, however, will have a recurrence of liver cancer elsewhere in the liver. Moreover, it should be noted that the survival rate of untreated patients with similar sized tumors and similar liver function is probably comparable.

Some studies from Europe and Japan have shown that survival rates with alcohol injection or radiofrequency ablation procedures are comparable to the survival rates of those patients who underwent resection. But again, the reader should be cautioned that there are no head-to-head comparisons of these procedures versus resection

The liver is a vital organ, meaning that one cannot live without it. The liver serves many critical functions including metabolism of drugs and toxins, removing degradation products of normal body metabolism (for example clearance of ammonia and bilirubin from the blood), and synthesis of many important proteins and enzymes (such as factors necessary for blood to clot). The liver, located in the right upper quadrant of the abdominal cavity, is divided into eight (8) segments reflecting the eight (8) major divisions of the portal vein and the bile duct.   

Blood enters the liver from two channels, the hepatic artery and the portal vein, bringing nutrients and oxygen to liver cells, also known as hepatocytes, and bile ducts. Blood leaves the liver via the hepatic veins which drain into the inferior vena cava which immediately enters the heart. The liver makes bile, a liquid that helps dissolve fat and eliminate metabolic waste and toxins via the intestine. Each hepatocyte creates bile and excretes it into microscopic channels that join to form bile ducts. Like tributaries joining to form a river, the bile ducts join to form a single “hepatic duct” that brings bile into the intestine.