Hepatectomy (Liver Resection)

Hepatectomy, also known as liver resection, is a surgery to remove part of the liver. It’s often done to treat liver cancer, like hepatocellular carcinoma, and other liver issues. Skilled surgeons perform this complex surgery with great care.

This guide covers hepatectomy in detail. It talks about when the surgery is needed, the techniques used, what recovery is like, and long-term results. Knowing about liver resection helps patients and their families understand what to expect during treatment.

What is Hepatectomy (Liver Resection)?

Hepatectomy, or liver resection, is a surgery to remove part of the liver. It’s done to treat liver issues like cancer, benign tumors, and tumors that have spread to the liver. The amount of liver removed depends on the tumor’s size, location, and number.

A partial hepatectomy is a common type. It removes only the part of the liver with the tumor. This helps get rid of the cancer while keeping healthy liver tissue. The liver can grow back to its normal size and function after this surgery.

Liver resections vary based on where and how much liver is removed:

Choosing to do a hepatectomy depends on many factors. These include the patient’s health, liver function, and the tumor’s details. Doctors use CT scans and MRI to plan the surgery and decide how much liver to remove.

Indications for Liver Resection

Liver resection, or hepatectomy, is a surgery for different liver issues. This part will look at when liver resection is needed. We’ll focus on treatments for hepatocellular carcinoma, metastatic liver cancer, and benign tumors.

Hepatocellular Carcinoma (HCC)

Hepatocellular carcinoma (HCC) is the main type of liver cancer. For those with early HCC and good liver function, surgery is often the best choice. Removing the tumor can give a chance for long-term survival or even cure.

Metastatic Liver Cancer

Metastatic liver cancer happens when cancer from another place spreads to the liver. Most often, this comes from colorectal cancer. For some patients with few liver metastases, surgery can greatly improve survival chances. A team approach, including chemotherapy and surgery, is the best way to fight this cancer.

The table below shows survival rates for patients with colorectal liver metastases based on treatment:

Benign Liver Tumors

Most benign liver tumors don’t need treatment. But, some can cause problems or risks. Surgery might be needed for large, symptomatic tumors like:

• Hepatic adenomas: These can burst and bleed, so they need to be removed.
• Giant hemangiomas: Big ones that hurt or press on other parts might need surgery.

Choosing to have surgery for benign tumors depends on the tumor’s size, where it is, and how it affects the patient’s life.

Types of Hepatectomy Procedures

Hepatectomy, or liver resection, is a surgery to remove part of the liver. This is done when the liver has cancer, benign tumors, or other issues. The size and location of the tumor and the liver’s health decide how much is removed.

Partial Hepatectomy

A partial hepatectomy removes only the affected part of the liver. It leaves the healthy parts alone. This is often used for small tumors in one area of the liver. It’s the most common type and has fewer risks than bigger surgeries.

Lobectomy

The liver has two lobes: right and left. A lobectomy removes one lobe. It’s done when the tumor is in one lobe and the other lobe is healthy enough to take over.

Extended Hepatectomy

An extended hepatectomy, or trisectionectomy, removes more than one lobe. It’s for large tumors or those in many liver segments. This surgery is more complex and risky than the others.

The choice of surgery depends on the tumor’s size and location, the patient’s health, and the liver’s function. A detailed check before surgery helps pick the best option for each patient.

Preoperative Evaluation and Preparation

Before a liver resection procedure, patients go through a detailed preoperative evaluation. This step is key to making sure the patient is ready for surgery. It also helps improve their health for the best results.

The evaluation includes a full medical history check, physical exam, and diagnostic tests. Blood tests check liver function and tumor markers. Imaging like CT scans or MRI look at the tumor size and if it has spread.

Patients meet with a team of experts, including surgical oncology doctors. They work together to create a treatment plan that fits the patient’s needs and tumor details.

In some cases, patients need extra steps before surgery. This might include nutritional support or medications to help the liver. It’s to make sure the liver can heal well after surgery.

Patients get clear instructions on how to prepare for surgery. This includes diet changes, medications to skip, and post-surgery care plans. Following these steps and working with their surgical oncology team helps ensure a successful surgery and recovery.

Surgical Techniques for Liver Resection

Liver resection, or hepatectomy, uses different surgical methods. These depend on the tumor’s location and size, and the patient’s health. The goal is to minimize complications and speed up recovery. The main methods include open hepatectomy, laparoscopic hepatectomy, and robotic-assisted hepatectomy.

Open Hepatectomy

Open hepatectomy is the traditional method. It involves a big incision in the abdomen to reach the liver. This method is good for complex cases or big tumors. But, it has longer recovery times and more risks than minimally invasive methods.

Laparoscopic Hepatectomy

Laparoscopic hepatectomy is a minimally invasive technique. It uses small incisions and special tools for liver resection. This method has less pain, shorter hospital stays, and faster recovery. It’s becoming more popular thanks to better technology and surgeon skills.

A comparison of open and laparoscopic hepatectomy outcomes is presented in the table below:

Robotic-Assisted Hepatectomy

Robotic-assisted hepatectomy is a new, minimally invasive technique. It uses a robotic system to improve precision and dexterity during surgery. This method offers the benefits of laparoscopic surgery with better views and control. It’s a promising technology for expanding minimally invasive liver surgery.

The trend towards minimally invasive liver surgery shows the effort to improve patient outcomes. As techniques and technologies evolve, patients with liver tumors will have more options for effective and less invasive treatments.

Postoperative Care and Recovery

After a liver resection procedure, patients get detailed care to help them recover well. The hepatobiliary surgery team watches over them closely. They handle any issues that might come up.

Pain Management

Managing pain is key for comfort and healing after liver surgery. The team uses many methods, like:

• Intravenous pain medications
• Oral pain relievers
• Regional anesthesia techniques

Monitoring Liver Function

It’s important to keep an eye on the liver after surgery. The hepatobiliary surgery team checks:

• Liver enzyme levels
• Bilirubin levels
• Coagulation factors

These tests spot liver problems early. This lets the team act fast if needed.

Complications and Their Management

Even with better surgery, some problems can happen. Patients might face:

• Bile leakage
• Infection
• Bleeding
• Liver failure

The hepatobiliary surgery team knows how to deal with these issues. They use:

The hepatobiliary surgery team’s skill is vital. They help manage complications. This ensures the best results for patients after liver surgery.

Outcomes and Prognosis after Hepatectomy

The success of liver cancer surgery, like hepatocellular carcinoma treatment, depends on many factors. Patients with early-stage liver cancer who have hepatectomy usually do better. They have a better chance of survival compared to those with more advanced cancer.

Research shows that patients with early-stage hepatocellular carcinoma who get liver resection can live up to 5 years. Their survival rate can be between 60% to 80%. But, for those with advanced cancer or liver diseases like cirrhosis, the survival rates drop a lot.

Several things can affect how well a patient does after hepatectomy:

• Tumor size and number
• Presence of vascular invasion
• Extent of liver resection
• Liver function reserve
• Patient’s overall health status

It’s very important to have regular check-ups after liver cancer surgery. This helps catch any signs of cancer coming back. Doctors might use CT scans, MRIs, and blood tests to check on the liver and look for cancer.

New surgical methods, better care before and after surgery, and team work in treating hepatocellular carcinoma have helped improve results. But, there’s always a chance of cancer coming back. Some patients might need more treatments, like chemotherapy or a liver transplant, to keep their condition under control.

Advances in Minimally Invasive Liver Surgery

In recent years, minimally invasive liver surgery has made big strides. It offers patients safer and less invasive ways to have hepatectomy. Techniques like laparoscopic hepatectomy have changed liver surgery a lot. They bring many benefits to both patients and surgeons.

One big plus of minimally invasive surgery is how it affects the body less. Laparoscopic and robotic-assisted methods mean smaller cuts, less blood loss, and less pain after surgery. This leads to quicker recovery times and shorter hospital stays for patients.

The following table compares some key aspects of open and minimally invasive liver surgery:

New tools, imaging tech, and training for surgeons have improved minimally invasive liver surgery. Laparoscopic and robotic-assisted methods help surgeons work more accurately. This means they can do the surgery with less damage to healthy tissue. More patients can now get this surgery, even those with bigger tumors or health issues.

Choosing the Right Surgical Team for Your Hepatectomy

Choosing the right team for a complex surgery like hepatectomy is key. Look for a team that focuses on hepatobiliary surgery. They should have a good track record of successful liver surgeries.

The surgeons should know the latest techniques and understand liver anatomy well. This knowledge helps in performing the surgery safely.

Expertise in Hepatobiliary Surgery

Hepatobiliary surgery is very specialized. Your team should have surgeons who have specialized training. They should focus on liver, gallbladder, and bile duct issues.

These surgeons have the skills to handle liver surgery well. They know how to reduce the risk of problems during and after surgery.

Multidisciplinary Approach to Liver Cancer Treatment

It’s important to have a team that works together for liver cancer treatment. This team should include medical oncologists, radiation oncologists, and interventional radiologists. They work together to create a treatment plan that fits your needs.

This team approach ensures all parts of your treatment are well-coordinated. It helps in getting the best possible care for you.

When looking for a surgical team, ask about their experience and success rates. A good team will be open about their qualifications. They will also want to discuss your case in detail. Choosing the right team for your surgery means you’re getting top-notch care and the best chance for a good outcome.