Depending on how far the liver disease has spread, either individual liver lobes (liver resection) or several lobes at the same time (hemihepatectomy) are removed during liver surgery. If necessary, up to six of the total eight liver lobes can be removed during a hemihepatectomy. The surgery is often preceded by a liver biopsy to precisely diagnose the tumour in question.
Benign or malignant tumours are the main reason for liver surgery. They are generally offshoots (metastases) from other types of cancer in the liver rather than actual liver cancer, which stems from the liver.
The liver is an organ with a high regenerative capacity. If there is sufficient healthy liver tissue left after an operation, the liver can almost completely regenerate itself. Thanks to this capacity to regenerate, larger parts of the liver can also be removed during surgery. If tumours re-appear in the liver, the liver can also be operated on several times.
This article will not address the reasons for a liver transplant and carrying out this surgery.
What preparations are carried out before the procedure?
Before a liver operation is carried out, the type and spread of the tumour has to be precisely clarified. Different examinations such as ultrasound, computer tomography, MRI and a liver biopsy are often also carried out. Depending on the situation, a decision is made where and how to carry out the surgery. In the process, particular evaluations are made as to whether there will be sufficient healthy liver tissue left over for regeneration after surgery.
All the usual pre-operative assessments are required, such as a blood test, blood pressure measurement and an ECG. All blood-thinning medication must be discontinued prior to surgery. The operation is usually performed under local anaesthetic. This means the patient must have an empty stomach for the surgery.
How is the operation carried out?
Liver biopsy, liver puncture
Liver biopsy is primarily carried out to evaluate uncertain liver diseases. The exact site of the biopsy will be determined with an ultrasound examination before the liver puncture. Sometimes an infusion is also laid in the arm before the examination. Then the skin and the muscles are locally anaesthetised for the procedure. A puncture needle is subsequently pushed into the liver on the right side and tissue is taken. The puncture only takes a few seconds. The entire liver biopsy takes approx. 15 minutes and can be carried out on an outpatient basis.
Liver resection, hepatectomy
During liver surgery, specific metastases, individual liver lobes or several liver lobes can be removed, depending on how far the tumour has spread. The procedure can be carried out as an open operation with the opening of the abdominal wall or with the minimally invasive [laparoscopic technology]. The laparoscopic procedure is being used more and more frequently nowadays.
Firstly, the vessels and the bile ducts located around the tumour are pinched off and ligated. A sample of the liver tissue affected by the tumour is subsequently removed. When several lobes are removed (hepatectomy), a common bile duct must sometimes also be removed. In such cases, a duodenal sling will be sewn onto the remaining duct.
Thanks to modern "navigation aids", individual well isolated liver metastases can be precisely located and surgically removed using MRI and computer tomography.
What is the success rate of this procedure?
The success rate of liver surgery depends on the stage of the underlying disease. Nowadays, cure rates of up to 70% are achieved in patients with isolated malignant tumours of the liver. If the tumour is benign, the disease is usually remedied with the surgery.
What are the possible complications and risks of this procedure?
As with all surgery, the operation may occasionally lead to post-operative bleeding, nerve damage or infections. A blood transfusion is often required after larger liver operations due to the blood loss during surgery. In rare cases, it can result in the obstruction of the bile ducts with jaundice. Or to a leakage of bile into the abdomen, which sometimes makes a further operation necessary.
What happens after the operation?
After the surgery, the patient wakes up in the recovery room. Patients who undergo a liver operation must usually stay in hospital for a period of five to ten days. Regular follow-up checks are necessary to check the regeneration of the liver. Depending on the type of tumour, further measures such as chemotherapy or radiotherapy will be required to treat the underlying disease.