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 usually no long-term side effects after a liver resection. This is because the remaining liver can grow bigger and do all its normal functions within a few months of the operation.
Liver resection is most commonly used to remove secondary liver tumours that have come from a primary cancer in the bowel. Occasionally 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
- there are tumours close to big blood vessels
- lots of tumours are spread across both lobes of the liver
- the rest of the liver is not healthy.
Chemotherapy may be used to shrink tumours before surgery. This can make the operation safer and more successful. It may also be used after surgery to reduce the risk of the cancer coming back.
This is where the liver is removed (resected) in two stages. In the first operation, part of the liver is removed. Then a week or more later, there is a second operation, when another resection is done. This means the liver has a chance to grow before the second operation.
Sometimes it is possible to encourage the healthy part of the liver to grow. This is done before a liver resection, to:
- help make sure there is enough liver left after the operation
- reduce the risk of liver failure.
The doctor blocks a branch of the main blood vessel that carries nutrient-rich blood to the liver (the portal vein). This is called portal vein embolisation (PVE).
You usually have PVE in the x-ray department. You have a local anaesthetic to numb an area of your tummy (abdomen). The doctor uses an ultrasound scan to find the branch of the portal vein that supplies blood to the part of the liver with the tumour(s). Then they make a small cut in the skin and gently push a fine tube (catheter) into the portal vein. When the catheter is in place, they inject special glue or very small metal coils into it. This blocks the blood supply to that part of the liver.
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 will usually have to stay in hospital overnight for this treatment.
If PVE is successful, most people will have a liver resection operation about 3 to 6 weeks later. You may need to have more scans of your liver to help the doctors decide about this.
If you smoke, try to give up before your operation. This will help reduce your risk of chest problems, such as a chest infection. It will help your wound heal after the operation. Your GP can give you more advice, and you can read our information about giving up smoking.
You will have some tests a few days or weeks before surgery at a pre-assessment clinic. While you are there, a member of the surgical team will talk to you about the operation. You may also see the doctor who will give you your anaesthetic (the anaesthetist).
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.
Before the operation, make sure you talk to your nurse or doctor about any questions or concerns you have.
Enhanced recovery programmes (ERP)
Many hospitals follow an enhanced recovery programme. This can help reduce complications after surgery and speed up your recovery. The programme involves careful planning before your operation. This makes sure you are properly prepared and any arrangements that are needed for you to go home are already in place. You will be encouraged to:
- have high-protein and high-calorie supplements before and after your surgery
- get as fit as possible before your operation
- limit the amount of alcohol you drink
- stop smoking.
You will be given information about what to expect after your surgery and when you can expect to go home.
After your operation, you will be encouraged to start moving around as soon as possible. Sometimes this will be on the day of the operation.
The surgeon will try not to use any tubes or drains unless they need to. Any catheters and fluids that are given through a vein will be removed soon after surgery. You will also be allowed to eat and drink soon after surgery. After you have gone home, you will be seen regularly to make sure you are recovering well.
You can ask your doctor whether you are suitable for this type of recovery programme. Not all hospitals use ERP for surgery and it is not suitable for everyone.
After a liver resection, you will usually be in intensive care or a high-dependency unit for about 24 hours.
This is done routinely after major operations. The liver has a very good blood supply, so there is a risk that it may bleed after surgery. The doctors and nurses will monitor this by taking your blood pressure regularly.
Drips and tubes
You may have some of the following for a few days:
- A drip (infusion) into a vein in the arm or neck. This gives you fluids until you are eating and drinking again.
- A thin tube (wound catheter) that goes into the tummy, close to the wound. This gives painkilling drugs to the operation area.
- A thin tube going into your back. This gives you painkilling drugs that numb the nerves and stop you feeling sore (called an epidural).
- A tube that goes up the nose and down into the stomach (nasogastric tube). The nurses use this to remove fluid, so you do not feel sick.
- A drainage tube to remove fluid from the wound. This lets it heal properly.
- A small, flexible tube going into the bladder to drain urine into a bag. This is called a urinary catheter.
You will probably have some pain and discomfort after your operation, but this can be controlled effectively with painkillers. If the pain is not controlled, it is important to tell your doctor as soon as possible. This is so they can change your painkillers.
At first, you will need a strong painkiller, such as morphine. You can have this in the following ways:
- As injections.
- Through a pump attached to a needle in your arm, which you control yourself. This is called patient-controlled analgesia (PCA). You will be shown how to use it.
- Through a wound catheter. This is a fine tube that a doctor places near a nerve or under the wound during the operation. Doctors use the catheter to give a continuous infusion of local anaesthetic to the operation area.
- Through an epidural. A small tube is inserted in your back, into the space just outside the membranes surrounding the spinal cord. Doctors use this to give a continuous infusion of local anaesthetic into this space. This numbs the nerves in the operation area.
For the first few days after surgery, you may have a dressing over your wound(s). If you need to have any stitches or staples removed, this can be done after you have gone home. It is done by a district nurse in your own home or at your GP surgery.
Always let you doctor know if your wound becomes hot, painful or starts to leak fluid, as these are possible signs of infection.
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 to help prevent blood clots. The nurses may give you special boots to wear. These encourage blood-flow in your legs and reduce the risk of blood clots. You will also be encouraged to do deep breathing exercises. This helps prevent chest infections. A physiotherapist or nurse will show you how to do the exercises.
Most people can go home:
- 3 to 6 days after standard resection surgery
- 2 to 3 days after keyhole resection surgery.
You will need painkillers for the next few weeks. It may take up to 3 months after a resection before you start to get back to normal. For at least 8 weeks, you need to avoid lifting heavy loads, such as shopping, and doing things 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 may advise you not to drink alcohol for some time while your liver is re-growing.
Gentle exercise like regular, short walks will help build up your energy. You can slowly do more as you recover.
Some people take longer than others to recover. It depends on your situation, so try not to be hard on yourself.
It is usually fine to have sex any time after the operation if you feel ready. You may find you are too tired or that your sex drive is low, but this should get better as you recover.