Resection involves the partial or total removal of an organ. For individuals diagnosed with liver cancer, this treatment option offers the best chance for long-term survival or cure. Removing a tumor is the surest method of eliminating the cancer – and preventing its spread to other parts of the body. Fortunately, the liver’s remarkable regenerative ability allows it to continue functioning even when parts of it are removed.

Candidates for liver resection
Most candidates for surgical resection have tumors that are confined to their livers. In addition, patients should meet the following criteria:

• They must have enough remaining healthy tissue for normal liver functions after the diseased parts are removed. As much as three quarters of the liver can be removed during surgical resection as long as the remaining liver tissue is healthy.
• Removal of the tumor from the liver must be technically feasible. Tumors near important liver blood vessels may need to be treated using other methods, such as radiofrequency ablation (RFA).
• Patients with underlying cirrhosis may not tolerate as much of the liver being removed compared to someone without cirrhosis.

In assessing someone for liver resection, Jefferson’s physicians often use CT scans to examine the number, size and location of the liver tumors, as well as to exclude the spread of cancer to other parts of the body.

The procedure: Open resection
A standard liver resection surgery takes a minimum of three hours. For more hard-to-reach or advanced tumors, the procedure may take four to six hours to complete.

After the patient is anesthetized, Jefferson surgeons make an incision across the right upper abdomen, below the ribcage. They carefully remove the diseased portion of the liver and its supporting tissues with an ultrasonic scalpel dissector, which helps minimize bleeding. During the operation, a sterile ultrasound (U/S) probe is used to identify the tumor(s) within the liver. That helps the surgeon decide where to divide the liver tissue. In addition, the surgeon uses the U/S probe to search for any additional tumors that may not have been detected by the pre-operative CT scan. If there are any additional tumors, the surgeon will go ahead and resect them or destroy them with RFA.

Following the liver resection, patients often have a temporary drain in the abdomen. The drain exits the skin below the incision and allows clinician to watch for any post-operative bleeding or bile leakage from the cut edge of the liver. Bile leaks occur in less than 10 percent of liver resections. When they do occur, they usually seal in a few days without intervention. Most patients have the drain removed before going home.

Postoperative pain is controlled by either an epidural catheter placed by the anesthesiologist prior to the operation, or by a postoperative patient-controlled analgesia (PCA) pump. With this pump, the patient pushes a button and receives an intravenous dose of pain medication. Usually by the third postoperative day, the patient can transition to oral pain pills to control discomfort.

Patients usually stay in the hospital for four to five days after an open liver resection. On the first postoperative day, they may be able to drink fluids; a few days after the operation, they’re usually able to eat solid foods. Following their discharge, patients return to Jefferson one to two weeks later to examine the skin incision and discuss the need for any additional therapies, as well as their long-term follow-up plans.

Laparoscopic liver resection
Surgeons at Thomas Jefferson University Hospital are experts at minimally invasive, or laparoscopic, liver resection surgery. Certain benign or malignant tumors of the liver can be removed through three to four keyhole-sized incisions, much like those used for laparoscopic gallbladder removal.

With the laparoscopic procedures, patients typically experience less post-operative pain, can go home on the second post-operative day with just three to four small bandages covering the tiny incisions, and can get back to work much sooner.

Your team of Liver Tumor Program doctors at Jefferson will determine if you’re eligible for this type of surgery based on the tumor size and location.

Contact us
To schedule an appointment with a Jefferson physician call 1-800-JEFF-NOW or click here.

To contact the Liver Tumor Program team at the Kimmel Cancer Center at Jefferson, please call 215-503-8752 and/or fax your records to 215-503-8755. We aim to schedule your first clinic visit within two weeks of your diagnosis being made and records being received.