Liver Surgery

What Does The Liver Do?

It is an incredibly complex organ that detoxifies the bloodstream, makes enzymes for digestion, and makes many proteins. It weighs about 3.5 pounds, and about 2/3 can be removed in a healthy individual. It does regenerate.

Tumors of the Liver

The vast majority in the United States originate from other sites (metastases).  There is an increasing incidence of tumors that originate in the liver (hepatocellular carcinomas), that occur in a background of a diseased liver (fatty liver, cirrhosis, or hepatitis).

Liver Surgeries

The surgery depends on the size, location, and number of tumors, factoring in the underlying health of the liver as well as the patient.  Tumors can either be resected (removed) or ablated (destroyed with either cold, heat, electrical or microwave energy). As a rule, ablations are much better tolerated and are often performed either percutaneous or laparoscopically. The down side is the cure rate is lower than with resection. Below is a list of surgeries ranked from smallest to largest

• Ablation (radiofrequency, or microwave)
  • CT guided
  • Laparoscopically
  • Open laparotomy, as part of a combined resection
• Resection
  • Laparoscopically -- wedge resections/segmentectomy
  • Open, through an incision
    • Wedge
    • Segmentectomies
    • Right or left hepatic lobectomy (removal of half of the liver)
    • Right or left trisegmentectomy (removal of 2/3of the liver)

The complication rate depends on whether an ablation or resection has been performed and the size of the resection

• Ablations carry a 5 to10% complication rate and a mortality of less than 1%
• Resections carry a 20 to 40 % complication and a mortality of 2 to 5%

Pre-Op Evaluation

• CT scan, possible MRI of liver, possible PET scan
• Assessment of liver function, pulmonary, and cardiac reserve
• Will need to have blood available for transfusion; bowel prep is unnecessary
• Do not take blood thinners 5 days before surgery.
• Ablations require minimal care
• Open liver resections you can shower, walking is encouraged, no lifting more than 10 pounds for 6weeks, no driving for about 4 weeks

Post-Op Care

• Ablations require minimal care
• Open liver resections you can shower, walking is encouraged, no lifting more than 10 pounds for 6weeks, no driving for about 4 weeks