The general principle behind liver cancer surgery is to treat and eliminate cancer from the liver. Therefore, the surgery is not likely to be effective for patients at advanced stages of liver cancer. This is mainly because liver cancer can spread out to other tissues of the liver, in addition to other organs, which can make liver surgery challenging in such cases.
In addition to the extent of disease, the health status of patient’s liver has to be taken into account. This includes several issues that may affect liver functions, such as liver cirrhosis. Therefore, the liver cancer surgeon will have to assess your liver condition in order to estimate whether the liver will be able to perform its vital functions after the cancerous parts are removed.
Treatment for liver cancer largely depends on the stage of the condition, which is best determined by an experienced liver doctor. The condition is categorized into four stages, which are:
A single tumor is found in or on the liver.
A single tumor has grown into the blood vessels or there are multiple tumors in the organ, all smaller than 5cm.
There are multiple tumors bigger than 5cm, or the cancer has grown into a major blood vessel, or grown into a nearby organ or outer covering of the liver.
The liver cancer has spread to nearby lymph nodes, or metastasize and spread to other body parts.
Diagnostic tools and imaging tests are often ordered first by the liver cancer surgeon to determine the number, size, location and spread of the cancer. Once the staging tests are done, a treatment plan tailored to the patient will be determined. The most common liver cancer treatments are:
In the earliest stages, if the tumor is small and affects only a small portion of the liver, part of the organ can be surgically removed. Hepatectomy is only for patients with a healthy and fully functioning liver. For those with cirrhosis, or whose cancer has spread extensively in the organ, this is not an option due to heightened risk of excessive bleeding and infections. This operation can be performed by laparoscopy or by open technique.
This involves the removal of the diseased liver and replacing it with a healthy one from a living or deceased donor. This is ideal for those who have a tumor smaller than 5cm, or multiple tumors no bigger than 3cm. It is not suitable for those in advanced stages, as the cancer may have already spread beyond the liver.
Alternatively, when the cancer has reached its final, incurable stage, treatment options will deal more with alleviating symptoms and slowing the growth of the tumor. These include radiation and drug therapies, palliative care and clinical trials. A liver cancer surgeon can help determine the most appropriate treatment based on the patient’s symptoms and overall health.
Generally, there are 2 options of liver cancer surgery, including open surgery and laparoscopy surgery.
Open surgery aims at removing liver tumors and cysts through making a large cut (known as the Chevron incision) around the abdominal area, which is about 15 to 18 inches in length.
Laparoscopic liver surgery
Laparoscopic liver surgery or Keyhole surgery is a favored option whenever feasible, which avoids making large cuts in the abdomen. Laparoscopic liver surgery is especially useful for removing liver tumors and cysts located on the liver surface and left lateral segment (lateral segmentectomy). Laparoscopic liver surgery may also be performed alongside 2 other procedures. These are:
After undergoing liver cancer surgery, the remaining parts of the liver are normally able to regenerate and should function properly. Depending on how much of the liver was removed during liver cancer surgery, patients may experience different recovery time and complications. Patients with liver cirrhosis may be at risk of liver failure after surgery if there is poor residual liver function before surgery. Also, liver cancer recurrence can also occur.
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