Surgery for primary liver cancer

Surgery is the most effective treatment for primary liver cancer, but isn’t always possible due to 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 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, depending on the position and size of the tumour and whether the liver is damaged by cirrhosis. Before any operation it’s important to discuss it fully with your doctor so that you understand what it involves.

Liver resection Back to top

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 the affected part. This is called a liver resection. If the operation involves the removal of 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 be back to normal within a few weeks.

Liver transplant Back to top

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 between 3–5cm
• a single tumour that is between 5–7cm that hasn’t changed in size for six months
• a maximum of five tumours, all smaller than 3cm in size.

Your specialist may suggest a liver transplant if you have cirrhosis of the liver. However, if your cirrhosis is severe you may not be well enough to go through 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 operation. 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.

Most people with primary liver cancer won’t be suitable for a liver transplant. This is because they will not be well enough or because the cancer has already begun to spread beyond the liver. There is also likely to be a wait for a suitable donor to become available, which can take many months. The cancer will continue to grow during this time and you will be given other treatments to control it.

If there is any risk that cancer cells may have spread, a liver transplant won’t cure the cancer and usually won’t be recommended. After a transplant operation you will need to take drugs so that your body doesn’t reject the new liver. These drugs, known as immunosuppressants, dampen down the immune system making it less effective at fighting against any cancer cells. So if the cancer had spread before the surgery you will have gone through a major operation only to have the cancer come back.

Your specialist can discuss if a transplant is suitable for you.

After your operation Back to top

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 is a risk that 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 takes place 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. This will save you having to get up to pass urine. It’s usually removed after a few days.

Pain

It’s normal to have some pain or discomfort after an operation on the liver. You’ll be given regular injections of painkillers for several days after the operation to prevent and relieve pain.

Nausea (sickness)

Some people feel sick after an operation. You may be given injections of anti-sickness drugs (anti-emetics) to help prevent and relieve this.

Going home

Most people are able to go home 6–12 days after their operation and will need painkillers for the next few weeks. It may take up to six weeks 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 when you are admitted to the ward so that help can be arranged.

Your nurse specialist can offer or arrange support or counselling for you and your family. Social workers are often available to give practical advice. Many are also trained counsellors. If you would like to talk to a social worker you can ask your specialist nurse to arrange it for you.

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 problems or worries before this time, you can speak with your ward nurses or hospital doctor.