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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REFERENCES:
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
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