Liver Surgery

• Hepatocellular carcinoma (HCC) - the most common primary liver cancer, often arising in patients with hepatitis or cirrhosis
• Colorectal liver metastases (CRLM) - bowel cancer that has spread to the liver, which can frequently still be cured with surgery
• Cholangiocarcinoma - cancer of the bile ducts within or adjacent to the liver
• Liver cysts and benign liver tumours that cause symptoms or diagnostic uncertainty
• Metastases from other cancers, including neuroendocrine tumours

The liver is divided into eight segments, each with its own blood supply and bile drainage. A liver resection removes the segment or segments containing the tumour while leaving enough healthy liver behind to function normally. Operations range from removal of a small wedge of tissue to a major hepatectomy in which more than half of the liver is removed.

The remaining liver regenerates over the following weeks, regaining most of its original volume. Where appropriate, resections are performed laparoscopically, using small incisions and a camera, which reduces pain and speeds recovery.

Careful planning is central to safe liver surgery. Before your operation you will have detailed CT and/or MRI scans, blood tests to assess liver function, and a review at the multidisciplinary team meeting. In some patients the tumour is treated with chemotherapy first, or the operation is planned in two stages, so that enough healthy liver remains after surgery.

You may also be asked to attend a pre-admission clinic where your fitness for a general anaesthetic is assessed.

Most patients stay in hospital for three to seven days depending on the size of the resection and whether keyhole or open surgery was used. Pain is controlled by the hospital pain team and you will be encouraged to walk early to reduce the risk of complications.

Strenuous activity and heavy lifting should be avoided for about four to six weeks. Follow-up includes wound checks, blood tests and surveillance scans arranged in conjunction with your medical oncologist.