Hepatectomy (Liver resection)

Overview

A hepatectomy, also known as a liver resection, is a surgical procedure that involves the partial or complete removal of the liver. The liver has the ability to regenerate, growing back to its original size if the remaining portion is healthy. If the patient’s liver is healthy, they can remove up to two-thirds of it. A liver transplant will be necessary if they have a total hepatectomy.

A liver resection may be performed to address liver disease or for those opting to give a portion of their liver for living donor liver transplantation.

Hepatectomy is regarded as a technically challenging procedure. The liver contains numerous vessels and is prone to substantial bleeding, requiring specialized training for liver surgeons to avoid vessel injury and effectively handle any bleeding. If the resection involves less than half of your liver, the procedure carries lower risks and can be performed using minimally-invasive surgical techniques like laparoscopy or robotic surgery. It becomes riskier and more challenging when the patient requires a major resection (the removal of more than half of their liver). Because of the complexity of the procedure, patients typically prefer to have their liver resection performed by qualified professionals.

Types

Major and minor liver resections are two distinct types for liver resections. A large resection is defined as the removal of more than three segments, whereas a minor resection is the removal of smaller pieces.

Common surgical procedures are as follows:

• Major liver resection: The right or left lobe (hemiliver) is removed during a right or left hepatectomy or lobectomy.
• Minor liver resection: By removing a segment or a portion of a segment with a tumor and a margin surrounding it, a wedge or segmental resection is performed. Another minor liver resection that involves removing the left lobe’s lateral section is called a left lateral sectionectomy.
• Two-stage liver resection: The surgeon may do the resection in two stages if they believe it may be too risky to remove all tumors in one attempt. Part of the tumor is removed during the initial procedure. After that, the liver regenerates for several weeks, ensuring that after the second surgery, which removes the remaining tumors, they will have enough liver left.
• Multiple liver resections: It is possible to remove many tumors at once. If a surgeon believes that certain tumors would benefit from ablation therapy, they might opt to combine resection with ablation as part of the treatment strategy. If a surgeon believes that certain tumors would benefit from ablation therapy, they might opt to combine resection with ablation as part of the treatment strategy.

Reasons for undergoing the procedure

Partial liver resection is the common procedure used by surgeons to remove a cancerous, precancerous, or benign (noncancerous) tumor.

There are two types of liver cancer: primary, which originates in the liver, and secondary, which originates in another organ and spreads.

Partial hepatectomy is used to treat the following liver tumors that occur most frequently:

• Hepatocellular carcinoma (primary liver cancer).
• Cholangiocarcinoma (primary liver cancer).
• Metastatic colorectal cancer (secondary liver cancer).

Among the other benign lesions are the following:

• Gallstones in the intrahepatic ducts.
• Liver cysts.
• Adenoma (primary benign tumor).

Risk

Complications may include:

• Infection.
• Bleeding.
• Bile leakage during surgery
• Pleural effusion.
• Ascites.
• Deep vein thrombosis.
• Kidney failure.
• Liver failure.

A 2% mortality rate is attributed to complications following liver resection surgery. Individuals with cancer assess these risks in relation to the risks of cancer.

Procedure

Hepatectomy procedures can be carried out using robotic, laparoscopic, or open surgery. The best course of action to treat their disease will be decided by the surgeon.

Because laparoscopic and robotic procedures involve four to six tiny incisions, each measuring around half an inch, they are less invasive than other surgical methods. A quicker and simpler recovery is possible with these tiny incisions. However, more complex or extensive liver resections could require traditional open surgery to handle.

Before the procedure

The healthcare provider must weigh a number of factors while determining the best course of action to treat the disease. First, they will assess the patient’s general health to see if they are healthy enough to undergo surgery. Additionally, the decision may depend on whether the lesion in your liver is technically operable and whether you have cancer in other parts of your body, aside from your liver.

Occasionally, to reduce the size of the cancer, make the surgery safer and simpler, or increase the likelihood that the cancer will be cured, radiation treatment, chemotherapy, or interventional radiology are performed prior to surgery.

The decision on whether to do a liver transplant or a partial hepatectomy will also fall to the healthcare provider. This could depend on:

• The extent of the tumor.
• The health status of the liver.
• The amount of functional liver remaining post-resection.
• Eligibility for a transplant

The healthcare provider might recommend to do certain tests on the patient to check for certain factors, such as:

• Imaging tests, includes CT scan or an MRI.
• Liver function test is to assess the health of the liver.
• Liver biopsy.

During the procedure

There are differences in the process based on the surgeon’s approach and the amount of liver removed. The hepatectomy procedure may proceed with the following steps:

• Prior to the surgery, the patient will be put to sleep with general anesthesia. In the event of open surgery, a transversus abdominis plane (TAP) nerve block may also be performed, which can help in post-operative pain management.
• If the patient is undergoing open surgery, the abdominal cavity will be opened by the surgeon making a single, lengthy incision across the patient’s abdomen.
• In the event that laparoscopic surgery is being performed, the surgeon will create four to six “keyhole” incisions to accommodate the laparoscope and other surgical equipment.
• The liver portion that requires removal will be determined by the surgeon. To map the liver, they could employ intraoperative ultrasonography. They could also have to remove their gallbladder if the area that has to be removed is close to it.
• The surgeon will meticulously dissect the liver tissue, isolating the blood vessels and bile ducts and securing them using metallic clips or staplers. They dissect the liver and regulate bleeding using electrocautery or ultrasonic energy instruments.
• The surgeon doing laparoscopic or robotic surgery might need to make an extra 2- to 5-inch incision to remove the resected liver from the body. The extent of liver removal and the size of the tumor determine the size of the incision.

Depending on how much of the resection, the surgery might take two to six hours.

After the procedure

Most patients will first recover in a post-anesthesia facility before being admitted to an in-patient room. Patients undergoing difficult surgical procedures might have to spend one or two days in critical care after the procedure. They will be equipped with a number of tubes that drain fluids, decompress their stomachs, and provide nutrition. The medical team will keep a careful eye on the patient’s blood glucose levels, fluid/electrolyte balance, and blood loss while they are in critical care. If any abnormalities arise, they will be treated.

The patient will continue to recover in the hospital for up to a week after their condition has stabilized. Gradually, they will start moving about more, restart eating solid food, and have the tubes taken out by the healthcare provider. While they recover, they will take painkillers. Following their discharge, they will schedule a follow-up meeting with their surgeon for two weeks to review the results of their final pathology report and talk about their progress.

Outcome

Among all cancer treatments, surgery has the highest rate of success. Surgery may be curative if it completely eliminates the cancer. Whether patients have an open, robotic, or laparoscopic treatment, the survival percentage remains the same.

Recovery from a liver resection at home takes four to eight weeks. The patient might have to take a leave from work during this period. During their recovery, individuals shouldn’t attempt to move anything heavy or partake in physically demanding activities. They can take up to 12 weeks to resume all of their regular activities.

Following robotic or laparoscopic surgery, recovery is typically faster. It will take six to eight weeks for them to be able to resume their regular activities after recovering at home for two to four weeks.

A healthy diet rich in protein and daily light activity, such as walking, assists in speeding the healing process. Every day, try to walk for at least thirty minutes, taking breaks as necessary.

Speak with the healthcare provider about any typical post-hepatectomy symptoms, such as:

• Bleeding or discharge from the incision site.
• Fever (persistent)
• Diarrhea.
• Vomiting.
• Constipation (more than three days).
• Swollen or distended abdomen
• Jaundice.