Liver Cancer Surgery

Advances in Surgery

Doctors are continually experimenting with better ways to perform liver cancer surgery. Laparoscopic surgery, a minimally invasive surgery where tiny cuts are made in the abdomen, is one example. In this procedure, your doctor uses long, thin instruments to find and remove sections of the liver that have been invaded by cancer.

Surgery is currently the only treatment that has the potential to cure liver cancer. However, because liver cancer is usually found at an advanced stage and because many people who have liver cancer have other health issues, only a small percentage of people are eligible for this approach.

If you are a candidate for surgery, you may receive a partial hepatectomy, in which a portion of the liver is removed, or a total hepatectomy, where the entire liver is removed and replaced with a donated liver.

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Partial hepatectomy

A partial hepatectomy may involve removing a wedge of tissue that contains the liver tumor, an entire lobe, or an even larger portion of the liver. That decision will depend on the size, number, and location of the tumors, as well as how well the liver is working.

In a partial hepatectomy, up to 80% of the liver can be removed. The healthy tissue that remains takes over the functions of the liver. New cells will grow to replace the removed portion over the course of several weeks.

A partial resection may not be possible depending on where the tumors are located, or if the rest of the liver is too damaged for a partial hepatectomy to be viable. In these cases, a liver transplant may be an option.

Total hepatectomy

Waiting for a Transplant

If you’re eligible for a transplant, your name is put on a national waiting list run by the United Network of Organ Sharing. Those who are the sickest and are the most likely to survive receive organs first. Since liver cancer is not currently one of the most curable liver diseases, few people with liver cancer receive donated livers.

In this procedure, known as a liver transplant, your liver is replaced with a healthy liver from a donor.

Since there are relatively few livers available for transplant, this surgery is generally reserved for people who meet certain criteria. Usually, this means you either have one tumor smaller than five centimeters in diameter or fewer than four tumors each smaller than three centimeters in diameter, and are ineligible for a partial hepatectomy.

The donated liver may come from either a living or deceased person. You may receive a whole liver or part of a healthy liver. What you receive will depend on how healthy the rest of your liver is, the size of the donated liver, and whether the donor is living or deceased. If you receive a liver from a living person, you will receive a portion of the donor’s healthy liver. According to the Organ Procurement and Transplantation Network, about 6,000 liver transplants are performed each year, but only a very small percentage come from living donors.

While you wait for a donated liver to become available, your healthcare team will monitor you and provide other treatments as necessary. Some people will not have the time to wait for a new liver. These people may have a partial hepatectomy and then a transplant when a liver becomes available.

Radiofrequency ablation

Ablation is the process of destroying a body part, tissue, or bodily function. For liver cancer, the goal of ablation is to kill cancer cells. There are a number of ways this can be done, including the use of heat, drugs, hormones, and surgery, among others.

Radiofrequency ablation uses heat to destroy cancer cells. The heat comes from a special probe your doctor uses, which contains tiny electrodes. Sometimes he or she can insert the probe directly in your skin and only local anaesthesia is needed.

In other cases, your doctor may first make a small incision in the abdomen or make a wider incision to open the abdomen and then insert the probe through the opening. This procedure is done in the hospital under general anaesthesia.

Laser and microwave therapy are examples of two other treatments that use heat to kill cancerous liver cells.

Cryosurgery

Cryosurgery — also called cryoablation and cryosurgical ablation — freezes cancel cells to kill them. For this treatment, your doctor makes an incision into your abdomen and inserts a metal probe that typically contains liquid nitrogen or liquid carbon dioxide to freeze tissue. Your doctor may use ultrasound to help guide the probe.

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