Surgery for liver cancer

Cancer that starts in the liver is called primary liver cancer. The most common type develops in the liver cells (hepatocytes), but tumors may also develop in the bile ducts that connect the gallbladder to the liver. The primary treatment for liver cancer is the surgical removal of the affected part of the liver (hepatic surgery).

Surgery is unfortunately not an option for larger or more advanced liver tumors

Once the tumor grows too large, or progresses to a later stage, surgery will no longer be an option. We can try to shrink the tumor through other treatments such as chemotherapy. In very rare cases, a liver transplant might be an option. If this is the case for you, we will refer you to a liver transplant center.

Multidisciplinary teams

During hepatic surgery, your surgeon will make an incision underneath the ribs on the right side of your body in order to free up the liver to monitor the large blood vessels.

Liver cancer surgery – what to expect?

During hepatic surgery, your surgeon will make an incision underneath the ribs on the right side of your body in order to free up the liver to monitor the large blood vessels.

The part of the liver with the tumor will be removed by using special tools and techniques that can help us conserve as much liver tissue as possible and minimize blood loss. Some (smaller) tumors can be destroyed during the surgery by using techniques called radiofrequency ablation (RFA) or microwave ablation (MWA).

Effectiveness

The results of the treatment depend on the primary tumor, the treatment option(s), and any potential metastases.

Preoperative screening

You will meet your anesthesiologist at the outpatient clinic before your surgery for a consultation and a brief examination to assess your overall shape and potential particularities. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, those will be taken as well.

This preoperative screening will take approximately 20 minutes and will be the foundation of your anesthesia. Your anesthesiologist will listen to your lungs and heart and inspect your mouth and throat for the placement of the breathing tube that will be placed during surgery. Your anesthesiologist will also ask you:

if you have been under anesthesia before;
if you have any other illnesses or disorders;
if you have taken medicine against cancer before;
if you have had radiation therapy before;
if you have any allergies;
if you smoke;
if you drink alcohol;
if you use any medication, and if so, which.

It is important to know which medicine you take, which dose, and how often. Sometimes more examinations or tests are needed, such as: electrocardiogram (ECG), lung x-rays, a lung function test, or a blood test.

General and local anesthesia

Anesthesia can be general, local, or a combination of the two. General anesthesia means you will be completely unconscious, whereas local anesthesia means that a part of your body will be numb and motionless.

General anesthesia

General anesthesia completely sedates your body. You will be given a cocktail of sleeping medicine, pain killers, and sometimes a muscle relaxant through IV and will be unconscious within 30 seconds. You will be ventilated during the entire process.

During major surgery, we will place a respiration tube in your throat. For smaller surgeries, a small cap in the back of the throat will suffice. We closely monitor your heart rate, blood pressure, breathing, and temperature through our monitoring devices.

Local anesthesia

If you are given local anesthesia, you will be conscious during the surgery. The anesthesia is usually administered through an epidural in the spine, which temporarily numbs the body below. You may also receive pain medicine during or even after the surgery.

Your anesthesiologist will keep a close eye on your blood pressure, heart rate, breathing, and temperature in order to adapt the anesthesia if needed.

Most people undergoing major surgery will be given a mixture of general and local anesthesia.

Side effects and complications

Your surgical scar may be sore during the days following the operation. Some patients develop pneumonia due to reduced chest ventilation directly after the operation, while other patients may develop an abscess, subsequent bleeding, or bile leakage. Most side effects are easy to treat.

Patients who are in good shape can survive without up to 70% of their liver. This percentage is lower in people with liver cirrhosis, and those who have previously been treated with chemotherapy. All liver tissue will grow back; it will take approximately 3 weeks before your liver capacity will be back to normal.

After your surgery

Most patients will need to spend their first day after surgery at the Intensive Care. We will take you to a regular ward. Without any further complications, you will be able to go home after 5 or 7 days.

After the treatment, we will discuss a plan for regular screenings with you. These scheenings will include regular CT or MRI scans. You may require further chemotherapy treatment after your surgery.