Types of surgery for liver cancer

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.

Liver transplant

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 across or smaller
  • a single tumour that is between 5 and 7cm, which does not grow over 6 months
  • up to five tumours that are 3cm across or smaller.

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 sure that the cancer cells have not spread.

It can take time, sometimes months, for a donor liver to become available. You may have other treatments to help control the cancer during this time. Sometimes, the cancer may progress and a transplant is no longer possible.

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. This is 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 weaker. This means it may be less able to fight any cancer cells that have spread.

Recovering from a liver transplant takes a long time. It will take time to 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 about your care before or after a liver transplant. Your liver team will talk to you about what to expect before and after the operation.

Liver resection

This operation is usually suitable for people who:

  • have a single tumour or a limited number of tumours
  • do not have cirrhosis, or only 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
  • a whole lobe of the liver (this is called a hemi-hepatectomy).

But your 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.

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.

Before your operation

If you smoke, 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 heal after the operation. Your GP can give you more advice.

You will have tests to make sure you are well enough to cope with the operation. You usually have these 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 you talk to your team about any questions or concerns you have about the operation. If you think you might need help when you go home, tell the nurses as soon as possible. This means the staff can help you make plans in plenty of time.

You will usually be admitted to hospital on the morning of your operation. You will be given special compression stockings (TED stockings) to wear during and after the operation. This is to help prevent blood clots forming in your legs.

Enhanced recovery

Some hospitals have an enhanced recovery programme for certain types of surgery. Enhanced recovery programmes aim to reduce the time you spend in hospital and help you to recover as quickly as possible.

For example, you may be given a diet plan to follow and exercises to do before surgery. You may be given supplement drinks to take too.

This is to make sure you are as healthy as possible. It is sometimes called prehabilitation.

After surgery, the nurses will get you out of bed and encourage you to start drinking and eating as soon as possible. Research has shown that this can help improve your recovery time.

After your operation

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 check this by taking your blood pressure regularly.

Moving around

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.

Pain

There are effective ways to prevent and control pain after surgery. For the first few days you are usually given painkillers though a pump. This gives you a constant dose of the painkillers. The painkillers can be given in the following ways:

  • through a thin tube in your back (epidural)
  • into a vein
  • into the tissue 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.

Your wound

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 will usually have stitches that dissolve. But if you need to have any stitches or staples removed, these can be taken out after 10 days (or about 3 weeks if you have had a liver transplant). 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.

See also

Going home

After a liver resection most people can go home:

  • 5 to 7 days after open surgery, where you will have one large wound
  • 2 to 3 days after laparoscopic (keyhole) surgery for a smaller liver resection
  • 4 to 5 days after laparoscopic (keyhole) surgery for a bigger liver resection.

After a liver transplant, you will usually stay in hospital for 2 or 3 weeks. When you go home, you will have regular checks to make sure your body is not rejecting the new liver.

Recovery

You will need painkillers for the first few weeks after your surgery.

It may take up to 3 months after a resection before you start getting back to normal. For at least 8 weeks, you need to avoid lifting heavy loads, such as shopping or laundry. You will also need to avoid activities like vacuuming or gardening. This is to give your wound time to heal. 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 advise you not to drink alcohol for about 3 months. This is because your liver is growing to replace what has been lost. After a transplant, you need to avoid drinking 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. This should improve with time.

Some people take longer than others to recover. It depends on your situation, so do not put pressure on yourself.

Your check-up will be at the outpatient clinic. Your doctor will ask you about your recovery and talk to you about the results of your operation. This is a good time for you to tell them about any problems you have had. Remember that you can contact your doctor or nurse before your appointment if you are unwell or worried about anything.

About our information

  • References

    Below is a sample of the sources used in our primary liver cancer information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    Melloul E, Hübner M, Scott M, et al. Guidelines for perioperative care for liver surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. World J Surg. 2016; 40: 2425–2440. Available from: doi.org/10.1007/s00268-016-3700-1 [accessed Feb 2020] 

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    NICE. Regorafenib for previously treated advanced hepatocellular carcinoma. Technology appraisal guidance (TA555) [Internet]. 2019. Available from: www.nice.org.uk/guidance/ta555 [accessed Feb 2020]

    Vogel A, Cervantes A, Chau I, et al. Hepatocellular carcinoma: ESMO Clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology. 2018; 29 (S4): iv238–iv255. Available from doi.org/10.1093/annonc/mdy510 [accessed Feb 2020]    


  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Dr Paul Ross, Consultant Medical Oncologist.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.