Surgery for secondary cancer in the liver

It may be possible to remove the affected part, or parts, of the liver with surgery. This operation is called a liver resection. 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 usually takes about 4 to 6 weeks. You do not need to be in hospital while this happens.

Liver resection is most commonly used to remove liver tumours that have spread from a primary cancer in the bowel. Sometimes liver resection is used for tumours that have spread from other primary cancers.

Liver resection is a major operation that takes 3 to 4 hours. It is done by a specialist liver surgeon (hepatobiliary surgeon).

Liver resection may not be possible if:

• the cancer has also spread to other parts of your body
• your general health means you may not cope with a major operation
• lots of tumours are spread across both lobes of the liver
• the rest of the liver is not healthy.

You may have chemotherapy before surgery. This is to shrink the tumour, or tumours, and make surgery safer and more successful. You usually have the operation 4 to 6 weeks after chemotherapy. This gives your liver time to recover from the effects of chemotherapy.

You may have chemotherapy after surgery. This is to reduce the risk of the cancer coming back. You usually have this treatment about 4 to 6 weeks after surgery. This gives your liver time to recover from the operation.

Talk to your cancer doctor about whether surgery may be helpful for you.

In very rare circumstances, doctors might consider a liver transplant. This is an operation to remove the liver and replace it with a healthy one from a donor. There are extremely strict guidelines for this type of complex surgery in secondary liver cancer. So it is very rarely suitable or possible.

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 secondary liver cancer forum to talk with people who have been affected by secondary liver cancer, share your experience, and ask your questions.

In some situations, people have a liver resection using keyhole (laparoscopic) surgery.

The surgeon uses a laparoscope to see inside your tummy area (abdomen). This is a thin tube with a tiny camera at the end. It sends pictures to a video screen. The surgeon puts the laparoscope into the tummy through a small cut in the skin.

Laparoscopy

During this operation, the surgeon makes several small cuts (incisions) instead of one big cut. They usually need to make about 3 small cuts (5mm long) and 2 or 3 bigger cuts (12mm long) in your tummy. They sometimes remove part of the liver through a cut in the lower part of the tummy.

The main advantage of this type of surgery is that it leaves much smaller wounds. This means you have less pain after the operation and a faster recovery.

If you smoke, try to stop smoking 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.

At a clinic or when you are admitted to hospital, you will meet a member of the surgical team and a specialist nurse. They will talk to you about the operation. You may also meet the doctor who gives you the anaesthetic. They are called an anaesthetist.

Tell the surgical team if you have any questions or concerns about the operation. If you think you might need help when you go home, tell the nurses as soon as possible. This will give hospital staff time to help you make plans.

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 prevent blood clots forming in your legs.

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.

Most people can go home from hospital:

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

Some people might be able to go home earlier. Recovery is different for everyone. Your doctor will talk to you about when you will be able to go home.

You will need painkillers for a few weeks after surgery. It may take up to 3 months after a resection before you start getting back to normal.

There are things you can do to help your recovery after surgery:

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

You will have a check-up 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 if you are unwell or worried about anything, you can contact your doctor or nurse before your appointment.