Surgery for liver cancer

Surgery is the most effective treatment for primary liver cancer (also called hepatocellular carcinoma or HCC). The type of operation you have depends on:

• the number of tumours in the liver
• where they are in the liver
• how damaged the liver is from chronic liver disease.

There are two types of operation:

• a liver transplant – the surgeon removes the liver and replaces it with a liver from another person (a donor)
• a liver resection – the surgeon removes the part of the liver where the cancer is.

Only a few people with HCC can have surgery. Your surgeon and specialist nurse will tell you whether surgery is an option for you. They will explain what it involves and the possible complications or risks. An operation to your liver is major surgery. It is important to have all the information you need before you decide.

We understand that having treatment can be a difficult time for people. We are here to support you. If you would like to talk, you can:

• Call the Macmillan Support Line for free on 0808 808 00 00.
• Chat to our specialists online.
• Visit our liver cancer forum to talk with people who have been affected by liver cancer, share your experience, and ask your questions

This operation is usually suitable for people who:

• have only 1 tumour or a limited number of tumours
• do not have cirrhosis or have early-stage cirrhosis.

Cirrhosis damages the liver and stops it from working properly. It is a risk factor for HCC.

The surgeon removes the part of the liver where the cancer is. The amount of liver they remove depends on the size and position of the tumour or tumours. They may remove:

• only a small part of the liver
• a whole lobe of the liver – this is called a hemi-hepatectomy.

The liver needs to be working well so that the remaining liver can cope after the operation. There are not usually any long-term side effects after a liver resection. This is because the remaining liver can grow bigger and work as it did before. This takes about 4 to 6 weeks. But you do not need to be in hospital while this happens.

Some people also have tumour ablation during surgery. This uses heat to destroy cancer cells.

Some people might have a treatment called portal vein embolisation (PVE) a few weeks before a liver resection. PVE redirects the blood flow to the healthy part the liver and encourages it to grow. You might have this when surgery is possible but there may not be enough remaining liver left afterwards to work properly.

You might have open surgery for a liver resection. This is where the surgeon makes 1 large cut (incision). But surgeons often do a resection using keyhole surgery – this is also called laparoscopic surgery.

Instead of 1 large cut, the surgeon makes several small cuts. They insert a thin tube called a laparoscope into a cut to see into and work inside the tummy (abdomen). The laparoscope has a camera that gives a 3-dimensional (3D) magnified view of the inside of the body. The images are shown on a video screen.

Sometimes during keyhole surgery, the surgeon uses a fluorescent dye called indocyanine green (ICG). It shows up the blood vessels and the areas of the liver to be operated on. This helps the surgeon make sure the surgery is done very exactly. Because keyhole surgery leaves small wounds, you usually recover quicker.

Keyhole surgery may sometimes be done using robotic equipment. But this is not common. The surgeon controls instruments attached to robotic equipment using the video images as a guide.

After a liver resection, you will be in intensive care or a high-dependency unit for about 24 hours. If you have a liver transplant, you will usually be in intensive care for a few days.

This is normal after major operations. There is a risk the liver may bleed after surgery. The doctors and nurses will monitor you carefully for bleeding. Your nurse will check your blood pressure regularly.

The nurses will encourage you to start moving around as soon as possible. They will usually help you get out of bed the day after your operation or sooner. While you are in bed, it is important to move your legs regularly and do deep-breathing exercises. This helps prevent chest infections and blood clots. Your physiotherapist or nurse will show you how to do the exercises.

For a short time after the operation, you may have some of the following:

• A drip going into a vein in your arm or neck. This is called an intravenous infusion. It gives you fluids until you can eat and drink again. It can also give you painkillers and other medications.
• 1 or more drainage tubes coming from your wound if you have had open surgery. These drain away extra fluids, such as blood. They are removed when the fluid has reduced.
• A fine tube that passes down your nose and into your stomach or small intestine. This is called a nasogastric tube. It drains fluids from your stomach so that you do not feel sick. You may need this for several days
• A small, flexible tube in your bladder. This is called a catheter. It drains urine (pee) into a bag. This means you will not have to get up to pass urine. You usually only have this for a couple of days.

There are effective ways to prevent and control pain after surgery. For the first few days, you are usually given painkillers through a pump. This gives you a constant dose of the painkillers.

You may have painkillers in the following ways:

• through a thin tube in your back (epidural)
• into a vein
• into the muscles close to your wound.

You may have a button you can press to give yourself an extra dose of painkillers if needed. This is called patient-controlled analgesia (PCA). It is set so that you cannot have too much painkiller.

When you no longer need painkillers through a pump, you can take them as tablets. Tell your nurses and doctors if you are in pain. They can give you the dose of painkillers that is right for you.

For the first few days after surgery, you may have a dressing over your wound. The nurses will check your wound regularly to make sure it is healing well.

You usually have stitches that dissolve. But if you need to have any stitches or staples removed, these can be taken out after 10 days.

If you have had a liver transplant, the stitches or staples will be taken out after about 3 weeks. A nurse can do this in your own home or at your GP surgery.

Always tell your doctor if your wound becomes hot, painful or starts to leak fluid. These are possible signs of infection. Contact the hospital straight away if this happens when you go home.