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What is liver resection and why is it done?
Liver resection is the surgical removal of a portion of the liver. This operation is usually done to remove various types of liver tumors that are located in the resected portion of the liver. The goal of liver resection is to completely remove the tumor and the appropriate surrounding liver tissue without leaving any tumor behind.
Which patients with liver cancer undergo liver resection?
In patients with liver cancer (Hepatocellular Cancer, HCC), liver resection is limited to patients with one or two small (5 cm or less) tumors confined to the liver with no invasion of the blood vessels. As a result of these strict guidelines, in practice, very few patients with HCC can undergo liver resection. The biggest concern about resection is that following the operation, the patient can develop liver failure. The liver failure can occur if the remaining portion of the liver is inadequate (for example, because of associated cirrhosis) to provide the necessary support for life.
What is the goal of liver resection?
The goal of liver resection is to completely remove the tumor and the appropriate surrounding liver tissue without leaving any tumor behind. This option is limited to patients with one or two small (3 cm or less) tumors and excellent liver function, ideally without associated cirrhosis. As a result of these strict guidelines, in practice, very few patients with liver cancer can undergo liver resection. The biggest concern about resection is that following the operation, the patient can develop liver failure.
Can a portion of the remaining normal liver grow back?
When a portion of a normal liver is removed, the remaining liver can grow back (regenerate) to the original size within several weeks. A cirrhotic liver, however, cannot grow back. Therefore, before resection is performed for HCC, the non-tumor portion of the liver should be biopsied to determine whether there is associated cirrhosis.
What are the results (survival and recurrence) of liver resection?
For HCC patients whose tumors are successfully resected, the five-year survival is about 10% to 60%, depending on the tumor size and type. This means that 10% to 60 % of patients who actually undergo liver resection for liver cancer are expected to live five years. Many of these patients, however, will have a recurrence of liver cancer elsewhere in the liver. Moreover, it should be noted that the survival rate of untreated patients with similar sized tumors and similar liver function is probably comparable. Some studies from Europe and Japan have shown that survival rates with alcohol injection or radiofrequency ablation procedures are comparable to the survival rates of those patients who underwent resection. But again, the reader should be cautioned that there are no head-to-head comparisons of these procedures versus resection.
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Brown DB, Geschwind JF, Soulen MC, Millward SF, Sacks D. Society of Interventional Radiology position statement on chemoembolization of hepatic malignancies. J Vasc Interv Radiol. 2006 Feb;17(2 Pt 1):217-23.
Bruix J, Sherman M; Practice Guidelines Committee, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma. Hepatology. 2005 Nov;42(5):1208-36.
Garden OJ, Rees M, Poston GJ, Mirza D, Saunders M, Ledermann J, Primrose JN, Parks RW. Guidelines for resection of colorectal cancer liver metastases. Gut. 2006 Aug;55 Suppl 3:iii1-8.
Medically Reviewed by Paul Oneill, MD, Board Certified Oncology
Previous contributing medical editor: Leslie J. Schoenfield, MD, PhD
Top Liver Resection Related Articles
Chemo Infusion and Chemoembolization of LiverArterial chemotherapy infusion of the liver and chemoembolization of the liver (TACE) are used in the treatment of liver cancer. Chemotherapy is directly injected into the hepatic artery so that a higher concentration of chemotherapy agents reach the tumors without subjecting the patient to the toxicity of the chemotherapy. Intra-arterial chemotherapy can cause the following side effects:
- inflammation of the gallbladder(cholecystitis),
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- inflammation of the pancreas(pancreatitis).
CirrhosisCirrhosis of the liver refers to a disease in which normal liver cells are replaced by scar tissue caused by alcohol and viral hepatitis B and C. This disease leads to abnormalities in the liver's ability to handle toxins and blood flow, causing internal bleeding, kidney failure, mental confusion, coma, body fluid accumulation, and frequent infections.
Symptoms include yellowing of the skin (jaundice), itching, and fatigue.
The prognosis is good for some people with cirrhosis of the liver, and the survival can be up to 12 years; however the life expectancy is about 6 months to 2 years for people with severe cirrhosis with major complications.
Hepatic HemangiomaHepatic hemangiomas are referred to as tumors, however, they not malignant and do not become cancerous. Hemangiomas can occur in the liver, however, they can also occur other places in the body. Symptoms are rare, however, they may cause pain, nausea, or enlargement of the liver. CT scan or MRI is generally used to diagnose hepatic hemangiomas Most hepatic hemangiomas do not require treatment.
Liver (Anatomy and Function)The liver is the largest gland and organ in the body. There are a variety of liver diseases caused by liver inflammation, scarring of the liver, infection of the liver, gallstones, cancer, toxins, genetic diseases, and blood flow problems. Symptoms of liver disease generally do not occur until the liver disease is advanced. Some symptoms of liver disease include jaundice, nausea and vomiting, easy bruising, bleeding excessively, fatigue, weakness, weight loss, shortness of breath, leg swelling, impotence, and confusion. Treatment of diseases of the liver depends on the cause.
Liver Disease QuizWhat is liver disease? Take the Liver Disease Quiz and test your knowledge about this organ and its function.
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Liver TransplantA liver transplant may be needed when the liver functions inadequately. Patients on the waiting list for a liver transplant are given a priority score based on their creatinine, bilirubin, and INR. Complications of liver transplantation include rejection of the donor organ and infection.
Percutaneous Ethanol Injection of Liverpercutaneous ethanol injection of the liver, pure alcohol is injected through the skin into liver cancers to kill the cancer cells. Doing this deprives liver cancer cells of water through dehydration. The most common side effect is leakage of alcohol onto the liver's surface, which can cause pain and fever.
Proton Beam Therapy of LiverProton beam therapy is a technique that delivers high doses of radiation to a specific area, or tumor, on the liver. There is not much data about the effectiveness of this procedure for the treatment of liver cancer.
Radiofrequency AblationRadiofrequency ablation (RFA) of the liver is a technique used to treat liver cancer. RFA uses imagine procedures like CT scan, ultrasound, and MRI (magnetic resonance imaging) to guide the RFA probe into the area of the tumor. There are different ways to perform radiofrequency ablation. Side effects of radiofrequency ablation of the liver are pain after the procedure, injury to the bowel, and inflammation of the gallbladder. The procedure lasts approximately 10-30 minutes.
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