Surgery for liver metastases

Hepatic surgery is the most effective treatment for liver metastases from primary tumors in the colon or rectum. Treatment is often combined with chemotherapy. Some metastases from other primary tumors (such as melanoma, breast cancer, lung cancer, or sarcomas) can also be treated with surgery.

When is surgery an option?

Whether surgery is an option for you will depend on several factors: the tumor size, the amount of metastases, and the presence of metastases outside of the liver, as well as your overall health and shape.

Multidisciplinary teams

Treatment for liver metastases is often complex. Highly specialized surgeons collaborate with oncologists, gastroenterologists, radiation therapists and interventional radiologists to deliver your treatment.

Surgery for liver metastases - what to expect?

Surgery can be a highly effective but invasive way to treat liver metastases.

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(s) of the liver with the metastases will be removed 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 will depend on the primary tumor, the treatment option(s), and any potential additional metastases. Some patients develop new metastases in the liver or other organs such as the lungs.

Research has shown that the survival rates of patients with liver metastases in the colon or rectum after 5 years is about 50%. A smaller percentage is cancer free after 10 years.

Preoperative screening

Before your surgery, you will be invited to meet with your anesthesiologist at the outpatient clinic for a consultation and a brief examination to assess your overall shape and any potential particularities we will need to keep in mind. The consultation assistant will measure your heart rate and blood pressure and will inquire about your height and weight. If needed, we can take those measurements during the appointment.

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

whether you have been under anesthesia before
whether you have any other conditions
whether you have taken cancer medicine before
whether you have had radiation treatment before
whether you have any allergies
whether you smoke
whether you drink alcohol
what kind of medication you take

Please inform your anesthesiologist of the type of medication and dose you take, and how often you take it. Your physician may want to run more tests before your surgery, such as: electrocardiogram (ECG), lung x-rays, a lung function test, or a blood test.

General or local anesthesia

Before your surgery you will be given general anesthesia, local anesthesia, or a combination of the two. General anesthesia means that you will be completely unconscious during surgery, 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. You will be unconscious within 30 seconds. You will be ventilated during the entire process.

If you are having 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 will 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 your surgery. Local anesthetics are usually administered through an epidural in the spine, and will temporarily numb all body parts underneath. We may place a tube to give you IV pain medication during and after 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 anesthetics.

Side-effects and complications

Your surgical scar and the surrounding area may be sore after the procedure. Some people experience pneumonia due to difficulty breathing after the surgery, an abcess, bleeding or bile leakage. These complications can be treated.

Patients who are in good health can live without up to 70% of their liver without any problems. If you experience liver cirrhosis or have received chemotherapy, this may not be the case for you. Liver tissue grows back: most patients have fully recovered their liver capacity after approximately 3 weeks following the surgery.

After surgery

Most patients undergoing liver surgery will need to spend one day at our Intensive Care unit for observation, after which you will be moved to a regular ward. You will be able to go home after 5 to 7 days.

After the procedure, we will discuss a follow-up plan with you. The plan will include a CT scan and the tracing of new metastases in the blood with tumor marker CEA. You may need to receive chemotherapy after your surgery.