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 takes about 4 to 6 weeks. But you do not need to be in hospital while this happens.
Liver resection is most commonly used to remove secondary liver tumours that have come from a primary cancer in the bowel. Sometimes it is used for other primary cancers. You can talk to your doctor about whether surgery may be helpful for you.
Liver resection is a major operation that takes 3 to 4 hours. It is done in specialist units by doctors experienced in liver surgery (hepatobiliary surgeons).
A 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 to shrink the tumours before surgery. This can make the operation 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.
Chemotherapy may also be used after surgery 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.
This is where the liver is removed (resected) in two stages. In the first operation, part of the liver is removed. After a week or more, you have a second operation to remove more of the liver. This gives the liver some time to grow before the second operation.
The main blood vessel that carries blood to the liver is called the portal vein. A portal vein embolisation (PVE) is a procedure to block a branch of this vein.
Sometimes people have a PVE before a liver resection. The aim is to block blood flow to the part of liver to be removed. This stimulates the rest of the liver to grow.
- help make sure there is enough liver left after the operation
- reduce the risk of liver failure.
You usually have a PVE in the x-ray department. You have a local anaesthetic injection to numb an area of your tummy (abdomen). The doctor uses an ultrasound scan to find the area of the portal vein that supplies blood to the part of the liver with the tumour(s). They then make a small cut in the skin and gently push a fine tube (catheter) into the portal vein. When the catheter is in place, the doctor injects special glue or very small metal coils into it. This blocks the blood supply to that part of the liver.
A PVE usually takes 1½ to 2 hours. You may feel some gentle pushing as the doctor inserts the catheter. Tell them if you feel any pain or discomfort, so they can give you painkillers. You usually stay in hospital overnight after this treatment.
If a PVE is successful, you usually have a liver resection operation about 3 to 6 weeks later. You may have more scans of your liver during this time.
In some situations, people may have a liver resection using keyhole (laparoscopic) surgery to remove the affected part of the liver.
The surgeon uses a laparoscope to see inside your tummy. This is a thin tube with a tiny camera at the end. It sends pictures to a video monitor. The surgeon puts it into the tummy through a small cut in the skin.
For this type of operation the surgeon makes several small cuts (incisions) instead of 1 big cut. Usually they need to make about 3 small cuts (5mm) and 2 to 3 bigger cuts (12mm). The section of liver is sometimes removed from 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 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 to 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 prevent blood clots forming in your legs.
Enhanced recovery programmes (ERP)
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
After a liver resection, you will usually be in intensive care or a high-dependency unit for about 24 hours.
This is routine after major operations. There is a risk that the liver may bleed after surgery. The doctors and nurses will check this by taking your blood pressure regularly.
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.
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.
For the first few days after surgery, you may have a dressing over your wound(s). 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. 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. We have some tips for avoiding infection.
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.
You will need painkillers for the next few weeks. 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.
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.
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.
Macmillan offers emotional, financial and physical help. Find out how we can support you.
If you would like to talk, you can:
- Call the Macmillan Support Line on 0808 808 00 00.
- Chat to our specialists online.
- Visit our Online Community to talk to people who have been affected by secondary liver cancer, share your experience, and ask an expert your questions.
Below is a sample of the sources used in our secondary liver cancer information. If you would like more information about the sources we use, please contact us at firstname.lastname@example.org
NICE. Liver cancers overview [Internet]. 2019. Available from: pathways.nice.org.uk/pathways/liver-cancers/liver-cancers-overview [accessed Feb 2020]
The National Institute for Health and Care Excellence (NICE) Microwave Ablation for treating liver metastases. 2016. Available from: nice.org.uk/guidance/IPG553 [accessed February 2020].
The National Institute for Health and Care Excellence (NICE) Colorectal cancer: Guidance NG151. 2019. Available from: nice.org.uk/guidance/ng151 [accessed February 2020].
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.
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