Surgical Resection
Overview
Resection simply means the total or partial removal of an organ. For people diagnosed with liver cancer, liver resection offers the best chance for cure or long-term survival. Removal of a tumor is the surest method of eradicating the cancer and preventing its spread to other parts of the body. The liver's remarkable regenerative ability allows it to continue functioning even when parts of it are removed.
Candidates for Liver Resection
Most patients who are candidates for surgical resection have a tumor confined to their liver. To be selected for resection, patients must also have enough remaining healthy tissue for normal liver functions after the diseased parts are removed. As much as 75 percent of the liver can be removed during surgical resection as long as the remaining liver tissue is healthy. Removal of the tumor from the liver must be technically feasible; tumors located near important liver blood vessels may need to be treated using other methods such as radiofrequency ablation (RFA). Also, patients with underlying cirrhosis may not tolerate as much of the liver being removed compared to someone without cirrhosis.
To determine whether surgical resection is a viable option, doctors often use CT scans to look at the number, size, and location of the liver tumors, as well as to exclude the spread of cancer to extra-hepatic sites.
The Procedure (Open resection)
A standard liver resection surgery can be completed in a minimum of three hours, although more complex surgery required for hard-to-reach or advanced tumors may take four to six hours to complete.
After the patient is anesthetized, surgeons make an incision across the right upper abdomen, below the ribcage. They carefully remove the diseased portion of the liver and its supporting tissues with an ultrasonic scalpel dissector, which helps minimize bleeding. At the UPMC Liver Cancer Center, most patients can have a liver resection performed without requiring a blood transfusion.
During the operation, a sterile ultrasound (U/S) probe is used to identify the tumor(s) within the liver so that the surgeon knows where to divide the liver tissue. The U/S probe is also used to search for any additional tumors that may not have been detected by the pre-operative CT scan. If any additional tumors are seen, they will be resected or destroyed by radiofrequency thermal ablation (RFA) at the same time.
After the liver resection, patients often have a temporary drain (called J.P., or Jackson-Pratt drain) in the abdomen. The drain comes out through the skin below the incision to watch for any post-operative bleeding or bile leakage from the cut edge of the liver. Bile leaks occur in less than 10 percent of liver resections, and when encountered, they usually seal in a few days without any further intervention. Most patients have the drain removed before they are discharged.
Postoperative pain is controlled by either an epidural catheter placed by the anesthesiologist prior to the operation, or by a postoperative patient-controlled analgesia (PCA) pump. With the PCA pump, the patient pushes a button and receives an intravenous dose of pain medication. Usually by the third postoperative day, the patient can switch over to oral pain pills to control any discomfort.
Patients generally remain in the hospital for four to five days after an open liver resection. They may be able to drink fluids on the first postoperative day, and are usually able to eat solid food a few days after the procedure. Once discharged, the patients return to clinic one to two weeks later to examine the skin incision and discuss the need for any additional therapy as well as long-term follow-up plan.
Laparoscopic Liver Resection
Surgeons at the UPMC Liver Cancer Center have pioneered minimally invasive (laparoscopic) liver resection surgery. This means that certain benign or malignant tumors of the liver can be removed through three to four keyhole (band-aid) sized incisions similar to those used for laparoscopic cholecystectomy (gallbladder removal).
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Band-aid incisions after laparoscopic
liver resection for cancer |
More than 200 laparoscopic liver resections have been performed at UPMC. Patients have much less postoperative pain and are usually discharged home on the second postoperative day with three to four band-aids covering the tiny incisions. They also can return to work much sooner.
Your team of doctors at the Liver Cancer Center will determine if you are eligible for this type of surgery based on the tumor size and location.
What To Expect On My Surgery Day
All surgeries are performed at UPMC Montefiore. Your liver surgeon will see you in the operating room just prior to your surgery. Your family is welcome to accompany you to the hospital on the day of surgery. The surgical family waiting room is on the sixth floor of UPMC Montefiore. Volunteers are available to assist and support the family during this time. The liver surgeon will meet your family there to tell them about your condition when your operation is completed. Depending on the type of surgery that you require, the waiting time for your family may by four to five hours. Sometimes the surgery may take longer than expected due to scar tissue from previous operations.
Following several hours in the recovery room, if you are fully awake from the anesthesia and your vital signs (blood pressure, pulse, breathing, and temperature) are within normal ranges, you will be moved to the liver surgery floor, which is Unit 10 north at UPMC Montefiore. If you are not fully awake or require frequent vital checks because of abnormal ranges, you will be placed in the liver intensive care unit (ICU) overnight or as long as your condition requires you to stay there. The nursing staff on the surgical floor, surgical fellow, physician’s assistant, and/or nurse practitioner will assist with your care as you recover following your surgery. Depending on the type of surgery you have had performed, and your rate of recovery will determine the length of stay in the hospital. In general, the length of stay for laparoscopic surgery is one to two days, and for open surgery four to five days.
Your first postoperative visit is scheduled for 10 to 14 days after your surgery. The liver surgeon will evaluate your progress checking on your activity level, diet, incision, and pain management. If you have surgical staples, they will be removed at this visit.
Your next outpatient clinic visit is generally three months later. A CT scan is usually done at this time to make sure that the tumor has not recurred. If you develop a fever or other symptoms such as abdominal pain, nausea, vomiting or diarrhea, you should immediately contact us. We can decide if you need to return to see the doctor or if you can receive care from your doctor at home or a hospital closer to where you live.