Surgery is the most effective treatment for primary liver cancer. Liver cancer is also known as heptocellular carcinoma (HCC). The type of operation you have depends on the number of tumours in the liver and how damaged the liver is from chronic liver disease. Only a small number of people with HCC can have surgery.
There are two types of operation:
- a liver transplant – your liver is removed and replaced with a liver from another person (a donor)
- a liver resection – the surgeon removes the part of your liver where the cancer is.
Your surgeon and specialist nurse will tell you whether surgery is a possible 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.
The most common reason for a liver transplant is if a person has liver disease that is too advanced for other treatments. A liver transplant is only suitable for some people with HCC.
It can only be done if you have:
- a single tumour that is 5cm or less in size
- a single tumour that is between 5cm and 7cm, which does not grow over six months
- up to 5 tumours that are 3cm or less.
You need to be reasonably fit to cope with a transplant. Your liver team will assess you very carefully to make sure it is a suitable treatment for you. Your specialist also needs to be confident that the cancer cells have not spread.
It can take time, perhaps months, for a donor liver to become available. You may have other treatments to help control the cancer during this time. In some people, the cancer may progress so that a transplant is no longer possible.
Sometimes it may be possible to have part of a liver transplanted from a living donor. This is a newer type of operation and is only available in a few hospitals. The donor has surgery to remove a lobe of their liver, which is then transplanted into you after your diseased liver is removed.
After a transplant, you need to take drugs called immunosuppressants for the rest of your life. These stop your body from rejecting the new liver. But they make your immune system less able to fight any cancer cells that have spread.
Recovering from a liver transplant takes a long time. You have to gradually build up your health and fitness. It can take many months before you get back to doing everyday activities. We have not provided detailed information here about your care before or after a liver transplant. Your specialist liver team will talk to you about what to expect before and after the operation.
This operation is usually suitable for people who:
- have a single tumour or a limited number of tumours
- do not have cirrhosis, or have early-stage cirrhosis.
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 or a whole lobe of the liver (called a hemi-hepatectomy). But your liver needs to be working well so the remaining liver can cope after the operation.
In some hospitals, a resection may be done using keyhole surgery (laparoscopic surgery). Some people also have ablation treatment during surgery. This uses heat to destroy cancer cells.
You will have tests to make sure you are well enough to cope with the operation. These are usually done a few days before your operation at a pre-assessment clinic. They include tests on your heart and lungs.
You will see a member of the surgical team and a specialist nurse who will talk to you about the operation. You may see the doctor who gives you the anaesthetic (the anaesthetist) at a clinic or when you are admitted to hospital. Make sure that you talk through any questions or concerns that you have about the operation.
If you smoke, it is important to try to give up before your operation. This will help reduce your risk of problems, such as a chest infection. It will also help your wound to heal after the operation. Your GP can give you advice.
If you think you might need help when you go home after your operation, let the nurses know as soon as possible. It means the staff can help you make arrangements in plenty of time.
Some hospitals follow an enhanced recovery programme (ERP). This can help reduce complications following surgery and speed up your recovery. It involves careful planning before your operation to prepare you. You will have a high-protein and high-calorie drink before and after your surgery. After the operation, the nurses encourage you to start moving around as soon as possible. You will be allowed to eat and drink soon after surgery. Not all hospitals use the ERP for liver surgery and it is not suitable for everyone.
You will usually be admitted to hospital the day before your operation, or the same morning. The nurses will give you elastic stockings (TED stockings) to wear. These help prevent blood clots forming in your legs.
Drips and tubes
You may have some of the following for up to a few days:
- A drip (infusion) into a vein in your arm or neck. The nurses use this to give you fluids until you are eating and drinking again.
- A thin tube going into your back. This is called an epidural. It gives you painkilling drugs that numb the nerves and stop you feeling sore.
- A tube that goes up your nose and down into your stomach (nasogastric tube). The nurses use this to remove fluid so you don’t feel sick.
- A drainage tube to remove fluid from your wound, allowing it to heal properly.
- A small, flexible tube going into your bladder to drain urine into a bag. This is called a urinary catheter.
There are effective ways to prevent and control pain after surgery. You will usually have painkillers given into your back for the first few days. During surgery, the anaesthetist puts a fine tube into your back (an epidural). It connects to a pump that gives you a constant dose of painkillers.
Some people may have their painkillers given into a vein (intravenously). An electronic pump gives you a constant dose of painkiller. If you feel sore, you can give yourself an extra dose by pressing a button. It is set so you cannot give yourself too much. This is called patient-controlled analgesia (PCA).
When you no longer need the epidural or PCA, you will have painkillers as tablets. Let your nurses and doctors know if you are in pain, so they can give you the dose of painkillers that is right for you.
Most people are able to go home 5 to 8 days after a liver resection. If you have a laparoscopic resection, you can usually go home after a few days.
After a liver transplant, you will usually be in hospital for 2 or 3. When you go home, you will have regular checks to make sure your body is not rejecting the new liver.
You will need painkillers for a few weeks after the operation. It may take up to 3 months after a resection before you start getting back to normal. You need to avoid lifting heavy loads for at least 8 weeks. This is to give your wound time to heal.
It is also important to avoid more demanding activities, such as vacuuming and gardening. Your specialist will tell you when you should be able to drive again. Recovery takes longer after a transplant. Your doctor or nurse will tell you what to expect.
Make sure you get enough rest and eat well. This will help your recovery. Your liver specialist will tell you not to drink alcohol for about 3 months. Your liver is growing back during this time. After a transplant, you need to avoid alcohol and smoking.
Gentle exercise, such as regular short walks, will help build up your energy. You can gradually do more as you recover.
It is usually fine to have sex when you feel ready. To begin with, you may be too tired or your sex drive may be low, but this should improve with time.
Some people take longer than others to recover. It depends on your situation. At your check-up appointment, your doctor will talk to you about the results of your operation and any problems you may be having. But you can contact your doctor or nurse sooner if you are unwell or worried about anything.