Surgery for primary liver cancer
Surgery is the most effective treatment for primary liver cancer, but it isn’t always possible because of the size and position of the tumour. It’s also not possible to operate if the cancer has spread beyond the liver. If the liver is severely damaged by cirrhosis, it may not be safe for you to have surgery. Unfortunately, only a small number of people with primary liver cancer will be able to have surgery.
There are different types of surgery for liver cancer. The type you have will depend on the position and size of the tumour, and whether your liver has been damaged by cirrhosis. Before any operation, it’s important to discuss the surgery fully with your doctor so you understand what it involves.
It may be possible to remove the whole liver and replace it with a liver from another person (a donor). In the treatment of hepatocellular carcinoma (HCC), a liver transplant can only be done if you have:
a single tumour that is 5cm or less in size
a single tumour that is between 5 and 7cm that hasn’t changed in size for six months
two or three tumours that are all smaller than 3cm in size.
Your specialist may suggest a liver transplant if you have liver cirrhosis. However, if your cirrhosis is severe, you may not be well enough to have this major operation.
Most liver transplants are taken from people who have died (organ donors). In some situations, it may be possible to have a living-donor liver transplant. The donor has surgery to remove either the right or the left lobe of their liver, which is immediately transplanted into the patient. This is a newer type of operation and is not available in many hospitals.
A liver transplant won’t be suitable for most people with primary liver cancer. This may be because they’re not well enough, or because the cancer is too big or has already started to spread beyond the liver. It can also take some time – perhaps months – for a suitable donor to become available. The cancer will continue to grow during this time and you may be given other treatments to control it.
If there’s any risk that cancer cells may have spread, a liver transplant won’t cure the cancer and usually won’t be recommended. This is because after a transplant operation, you’ll need to take drugs called immunosuppressants so that your body doesn’t reject the new liver. However, these drugs also weaken the immune system making it less able to fight any cancer. So the cancer is likely to come back even though you’ve had a major operation.
You can discuss with your specialist if a transplant is suitable for you and they can tell you more about what’s involved.
If only certain areas of the liver are affected by cancer and the rest of the liver is healthy, it may be possible to remove only the affected part. This is called a liver resection. If the operation involves removing a whole lobe of the liver, it’s called a hemi-hepatectomy.
The liver has an amazing ability to repair itself. Even if up to 80% of the liver is removed, it will start to re-grow very quickly and may return to normal within a few weeks.
For about 24 hours after your operation, you may be nursed in the intensive care ward or high-dependency unit until you have fully recovered from the anaesthetic. The liver has a really good blood supply and there’s a risk it may bleed after surgery, so the doctors and nurses will keep a very close check on your blood pressure.
Drips and drains
You will have a dressing over the operation site on your abdomen and, if necessary, one or more drainage tubes will drain fluid and blood from the wound site into drainage bags. The nurses will regularly measure the amount of blood (if any) in these bags. When the drainage has almost stopped, the tube(s) will be removed. This usually happens after a few days.
You will have a drip (intravenous infusion) going into a vein in your arm to give you fluids and essential nutrients. This will be removed once you’re drinking and eating again – usually within 1–2 days.
A small tube called a catheter will be put into your bladder to drain urine into a collecting bag. It’s usually removed after a few days once you can get out of bed.
It’s normal to have some pain or discomfort after a liver operation. You’ll be given regular painkillers for several days after the operation to prevent and relieve pain.
Feeling sick (nausea)
Some people feel sick after an operation. You may be given anti-sickness (anti-emetic) drugs to help prevent or relieve this.
Most people are able to go home 6–12 days after their operation. You will need painkillers for the next few weeks.
It may take up to three months before you start getting back to normal.
If you think you might have problems when you go home (for example, if you live alone or have several flights of stairs to climb), let the nurse or social worker know. It’s best to tell them when you are admitted to the ward so that help can be arranged before you go home.
Before you leave hospital, you’ll be given an appointment to attend an outpatient clinic for your post-operative check-up. This is a good time to discuss any problems you may have.
If you have any concerns before this time, you can speak with your ward nurses or hospital doctor.