Liver Surgery

Why do I need a liver resection?
Liver resection is offered to patients who have or are thought to have a tumour (growth) on the liver. A tumour is an abnormal growth of cells and may be described as malignant (cancerous) or benign (non–cancerous). You may also be offered a liver resection if you have already had a bowel operation for bowel cancer and been found to have liver metastases (secondary cancer cells in the liver). The diagram below will be used to show you where
your tumour/s is. The liver is divided into eight segments and the detailed knowledge of the liver allows your Surgeons to plan your operation. Your
The surgeon will discuss with you the exact operation in more detail. You will have already undergone many tests and investigations. The results of these tests have been looked at carefully by a team of specialists known as the Multi-Disciplinary Team (MDT). This team includes Consultant Surgeons, Consultant Physicians, Consultant Radiologists (experts in taking and reading X-rays and scans) and Clinical Nurse specialists. The team has been able to make a diagnosis of your condition/illness, and a decision made about how best to treat it. As a result, they have suggested that
you have a liver resection. This will have been discussed with you. Only a relatively small number of patients with liver tumours are suitable for surgery, and whether or not this operation is an option for you depends on:

• Whether the tumour in your bowel has been treated/
is treatable.
• How much of the liver is affected.
• The size of the tumour(s).
• Where in the liver the tumours are located.
• Whether there are any tumours outside the liver.
• Your general level of fitness.

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What is a liver resection?
Liver resection is an operation to remove a part of the liver. If the right side of the liver is removed, this is known as Right Hemihepatectomy. The gallbladder is also removed at the same time. If the left side of the liver is removed this is known as a Left Hemihepatectomy.
The liver has the ability to repair and regenerate (grow back) itself. Up to 65% of the liver can be removed. The remaining liver will regenerate itself following surgery and will grow back to its original size in about 3 months. Most liver resections are performed during (open) surgery through
an incision (cut) in your abdomen. However, sometimes they may be done through (keyhole) surgery. This may not be suitable for some patients for a number of reasons including the size and/or the number of tumours to be removed as this makes the operation more complex.
Are there other types of treatment I could have? There are other treatments possible for liver tumours, which include ‘burning’ the tumour (ablation). This treatment is usually indicated in combination with liver surgery if there are many tumours to treat. It is also reserved for patients that cannot undergo a general anaesthetic. Radio-frequency ablation and microwave ablation are the two-ablation techniques that are commonly used.
Nearly all patients have chemotherapy after surgery. Some patients undergo chemotherapy before surgery. ‘Neo’-adjuvant or pre-operative chemotherapy is advised in certain situations where the tumours in the liver are too large to be removed. They require chemotherapy first to try and ‘shrink’ the tumours.

Are there any risks in having the operation?
As with all operations, the surgery and the anaesthetic carry risks to your health. Some of the risks of this operation can be serious. However, you will be under the care of a specialist team of Doctors and Nurses, who will monitor your condition to make sure that any complications that occur are treated as soon as possible. Liver resection is a major operation and is done under general anaesthetic. This means that you will be unconscious and unaware
of anything during the operation. The operation lasts between 2-6 hours but may take longer which means you will be under general anaesthetic for a long time.
The main risks of this type of surgery are:
Chest infection:
Because of the cut on your abdomen, you may find it difficult to breathe deeply or cough, which can lead to a chest infection. The Physiotherapist and Nurses will teach you breathing exercises to help prevent a chest infection. We also encourage you to be up and mobile as soon as possible after your operation. It is very important that you tell us if you have any pain, as this will prevent you from breathing deeply and mobilising. If you smoke, your lungs will be more sensitive to the anaesthetic. It would benefit you greatly to stop smoking or at least cut down before your operation. We are able to provide nicotine replacement therapy during your stay if required. 
Blood clots in the legs (deep vein thrombosis) or in the lungs (pulmonary emboli):
Moving around as soon as possible after your operation is recommended. We will give you special surgical stockings to wear whilst you are in hospital and injections to thin the blood. The Physiotherapist will show you some leg exercises to help prevent blood clots.
Wound infection:
Sometimes the wound can become infected. The Nurses will check
regularly for any signs of infection and keep the wound clean and
dry. If an infection does develop you may be given antibiotics. Very
occasionally, the wound may open and can then take a little bit
longer to heal.
A blood transfusion may be needed to replace blood lost during or after the operation.
Bile leak:
The liver can leak bile from where it has been cut. Should this happen you may need to have a drain inserted to help correct this. This usually settles down without any further intervention. In very rare cases, you may require further surgery.
Liver failure:
This is very rare. The remaining part of the liver is unable to function fully. This can lead to swelling of the legs, jaundice
(yellowing of the skin) and confusion. If this occurs the team of Surgeons will support your liver with medication until it recovers and may ask the liver medical specialists (Hepatologists) to be involved in your care.
Heart problems: 
Having a major operation can put stress on the heart. If you already have heart problems, the surgery may make these worse. Your team of specialists will speak to you in more detail about any heart concerns before the operation.
A small number of patients (less than 1%) who have this surgery may die within 30 days after surgery. This may be due to serious complications associated with this operation or as a result of some other medical problem. It is important to remember that you will be under the care of a specialist team of Doctors and Nurses. They will be closely monitoring your condition to make sure any complications are noticed and treated before they
become a serious risk to your life.

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