Surgery for secondary cancer in the liver
It may be possible to remove the affected part of the liver with surgery. This type of surgery is called a liver resection and is most commonly used to remove secondary liver tumours that have come from a primary cancer in the bowel.
Recent improvements in liver surgery mean that several tumours can sometimes be removed from more than one area of the liver in a single operation. However, it’s rarely beneficial to carry out a liver resection if there are also cancer cells in another part of the body.
Liver resection is a major operation that takes 3-7 hours. It’s carried out in specialist hospitals by doctors known as hepatobiliary surgeons, who are experienced in liver surgery. This treatment is only suitable for some people with secondary liver cancer. There are usually no long-term side effects following a liver resection. This is because the remaining liver can regrow within a few months of the operation and carry out all its normal functions.
You can discuss with your doctor whether surgery may be helpful for you.
Liver transplants, where the liver is removed and replaced, are not used for people who have secondary liver cancer, as the cancer usually comes back soon afterwards. This is due to the drugs that are used to prevent the body rejecting the transplanted liver.
Chemotherapy can be used to shrink tumours before surgery to make the operation safer and more successful, or after surgery to reduce the risk of the cancer coming back.
Make sure you have discussed any operation fully with your doctor so that you understand what it involves. Remember, no operation or procedure will be done without your consent.
Portal vein embolisation (PVE)
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Before removing part of the liver, it’s sometimes possible to encourage the healthy part of the liver to grow. This helps to make sure there is enough liver left after the operation and reduces the risk of liver failure. The procedure is done by blocking a branch of the main vein leading to the liver (the portal vein) and is called portal vein embolisation (PVE).
PVE is usually done in the x-ray department. Using ultrasound for guidance, a doctor will numb an area on your upper abdomen with a local anaesthetic, and then make a small cut in the skin. A fine tube (catheter) is then gently pushed into the cut and guided into the portal vein. Once the catheter is in the right place in the liver, special glue and/or very small metal coils will be injected to block off the area.
PVE usually takes between 90 minutes and 2 hours. You may feel some gentle pushing as the catheter is inserted. Tell your doctor if you feel any pain or discomfort; they can give you painkillers. You will usually have to stay in hospital overnight.
Staged liver resection
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This is where the liver is removed (resected) in two stages. Usually, part of the liver is removed in the first operation, and then another resection is done a few weeks after the first one, when the liver has had a chance to grow back.
Keyhole (laparoscopic) surgery
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In some situations, it may be possible to have keyhole (laparoscopic) surgery to remove the affected part of the liver. Several small openings are made instead of one larger cut (incision). Generally about three small cuts and one larger cut are needed.
The surgeon uses an instrument called a laparoscope to see and work inside the tummy (abdomen). The laparoscope is a thin tube with an eyepiece at one end, and a light and a magnifying lens at the other. It’s put into the abdomen through a small cut in the skin. The larger cut is usually made close to the belly button and is used to remove the affected part of the liver.
The main advantage of this type of surgery is that it leaves a much smaller wound, so pain after the operation is reduced and recovery time is shorter. Keyhole surgery should only be carried out by surgeons with specialist training and experience in using laparoscopic techniques. So if it’s suitable for you and you choose to have this type of surgery, you may need to travel to another hospital to have the operation.
You may be taken to the intensive care ward or high-dependency unit for about 24 hours. This is because the liver has a very good blood supply and there is a risk that it may bleed after surgery. The doctors and nurses will keep a close check on your blood pressure.
Drips and drains
You’ll have a drip (intravenous infusion) going into a vein in your arm (or into a central line in your chest, if you have one) to give you fluids and essential nutrients. This will be removed once you’re eating and drinking properly again, which is usually within a few days.
You may also have one or two thin drainage tubes leading from the operation site, with bottles attached to collect any fluid from the wound site. This helps the wound to heal properly. The nurses will regularly measure the amount of blood (if any) in these bottles. When the drainage has almost stopped, the tube(s) will be removed. This usually takes place after a few days.
A small tube called a catheter will be put into your bladder to drain your urine into a collecting bag. This will save you having to get up to pass urine. It’s usually removed after a few days.
You’re likely to have some pain and discomfort after your operation, which will be controlled with painkillers. To start with you’ll need a strong painkiller, such as morphine. This can be given to you by injection or through a pump attached to a needle in your arm which you control yourself. This is called Patient Controlled Analgesia (PCA) and you’ll be shown how to use it.
Some people may have a different method of pain relief called an epidural. A fine tube is inserted through your back into the area just outside the membranes around your spinal cord, called the epidural space. A local anaesthetic can be given continuously into this space to numb the nerves in the operation area. You may also be given injections of anti-sickness drugs (anti-emetics).
Most people are able to go home 4-8 days after their operation. You’ll probably need painkillers for a few weeks after. It may take up to six weeks before you start to get back to normal.