Introduction
The liver performs critical functions like detoxifying harmful substances, aiding digestion by secreting bile, storing energy, and overall balancing the metabolism. Yet, it is susceptible to all sorts of diseases and disorders, including liver tumors.
Liver tumors might be benign in nature in some instances, but others might become malignant and cause diseases like liver cancer (hepatocellular carcinoma). When liver tumors are found, treatment may differ according to a variety of factors like the size, location, and number of the tumors. A very popular procedure for treating tumors of the liver, particularly the malignant ones, is liver resection, which is also known as hepatectomy.
What is Liver Resection (Hepatectomy)?
Liver resection, or hepatectomy, is a surgical removal of a segment of the liver. The operation aims to remove tumors or diseased tissue and leave as much of the good liver intact as possible. Hepatectomy is one of the major therapies for patients who have liver cancer that is limited to one location in the liver, particularly if liver function elsewhere is normal.
Read Also: Fatty Liver Disease: Grades, Causes, Types, Symptoms & Treatment
When is Liver Resection Indicated?
Liver resection can be indicated in the following situations:
- Liver Cancer (Hepatocellular Carcinoma): Surgical resection is one of the best treatments for liver cancer, particularly if the cancer is localized to a single tumor. If the liver cancer is diagnosed early, and the patient's liver function is normal, surgery can offer the possibility of long-term survival or even a cure.
- Metastatic Liver Cancer: If cancer from another organ, for example, colorectal cancer, breast cancer, or pancreatic cancer, has metastasized to the liver (a condition referred to as metastatic liver cancer), liver resection can be considered if the number of metastases is small and the patient's liver function remains good. In such situations, removal of the metastatic lesions can enhance survival rates.
- Benign Liver Tumors: In some instances, benign liver tumors such as hemangiomas, focal nodular hyperplasia, or adenomas need to be resected if they are producing symptoms (such as pain, bleeding, or other issues) or if they are expanding in a manner that compresses nearby structures. Removal of these benign tumors by surgery can relieve and avoid future problems.
- Cirrhosis Patients: Liver resection can be challenging for patients with cirrhosis because their liver is scarred and may not function well after surgery. However, in carefully selected cases, where cirrhosis is mild and the liver is still working properly (compensated cirrhosis) surgery may be an option. This is usually considered if the tumor is small and there are no multiple tumors (multifocal disease).
Types of Liver Resection
Liver resections may be classified based on the tumor site and size. Some of the most common liver resections are:
- Partial Hepatectomy: Partial liver resection, where part of the liver is removed, is the kind of liver resection used in this procedure. The removal will depend on the size and position of the tumor. Partial hepatectomy is most commonly the operation for use in tumors that are resectable and do not affect the important parts of the liver or the main blood vessels.
- Right Hepatectomy: During a right hepatectomy, the right lobe of the liver, the larger half of the organ, is excised. This procedure is done when the tumors are in the right lobe of the liver. The procedure may involve the resection of the right lobe along with sections of the surrounding tissues or blood vessels depending on whether the tumor has grown into them.
- Left Hepatectomy: A left hepatectomy is where the left segment of the liver, less than the size of the right lobe, is removed. Cancers in the left lobe are often treated by removing this part of the liver. Whether the lower section of the left lobe is removed and leaving the remaining functional tissue intact depends on where the tumor is located.
- Extended Hepatectomy: In some cases, if the cancer is very big and affects greater than one liver lobe, greater resection of the liver may be required, which could involve removal of both the left and right halves of the liver. Extended hepatectomy is a more complex procedure and is performed when absolutely unavoidable.
Life Expectancy After Liver Resection
Life expectancy following liver resection can significantly differ depending on a number of variables, such as:
- Stage of Liver Disease or Cancer: If the liver tumor is diagnosed early and completely removed, the prognosis is usually good, with some patients surviving long-term. In patients with advanced liver disease or cancer, the prognosis may be less clear.
- Underlying Health Conditions: The overall health of the patient, such as liver function, cardiac status, and other comorbidities, can have a large impact on recovery and survival.
- Tumor Characteristics: The nature, size, and location of the tumor, along with whether it has metastasized to another organ or vessels, are all significant factors that come into consideration while forecasting prognosis. Tumors that remain localized in the liver and are successfully resectable have the most favorable prospect of being cured.
- Post-Surgery Recurrence: On occasion, tumors recur following liver resection, especially if cancer has extended outside the liver or if microscopic cancer cells have been left behind. Recurrence is based on cancer type and operative success.
- Such patients, after resection of the liver for benign disease or for early carcinoma of the liver, have a very good quality of life after convalescence and survive for years in considerable numbers. With advanced cancer, the prognosis may not be good but still there is hope of a few more days of survival or an increase in the quality of life by surgery.
Risks and Complications of Liver Resection
As with any dangerous surgery, liver resection comes with some danger and complications, including:
- Bleeding: The liver is very vascularized, and postoperative or intraoperative bleeding is a potential complication.
- Infection: With every kind of surgery, infection either at the time of surgery or in the liver is a complication.
- Liver Failure: Rarely, if more than enough liver is taken out or if the liver does not regenerate well enough, liver failure can occur.
- Bile Leak: The procedure can lead to a bile leak from the bile ducts, which can be accompanied by abdominal pain and other symptoms.
- Recurrence of Tumor: There is always a chance that the tumor can recur after surgery, especially in liver cancer patients.
Conclusion
Liver resection, or hepatectomy, is a significant surgical intervention utilized to treat liver tumors, especially those that are localized and resectable. Whether or not to have liver resection hinges on a variety of factors, such as the nature and size of the tumor, the general health of the patient, and whether there is underlying liver disease. Successful liver resection can provide a glimmer of hope for a cure and better survival, particularly in early-stage liver cancer.
Like any surgery, liver resection is not without risk, and close observation after the operation is necessary to allow for proper healing. Yet the liver's capacity to regenerate following surgery is a hope for many patients who have the procedure, with favorable results and extended life expectancy in most instances.
