Liver cancer surgery

At this time, surgery, either with resection (removal of the tumor) or a liver transplant, offers the only reasonable chance to cure liver cancer. If all known cancer in the liver is successfully removed, you will have the best outlook.

Partial hepatectomy

Surgery to remove part of the liver is called partial hepatectomy. This operation is only attempted if the person is healthy enough for surgery and all of the tumor can be removed while leaving enough healthy liver behind. Unfortunately, most liver cancers cannot be completely removed. Often the cancer is in too many different parts of the liver, is too large, or has spread beyond the liver.

Imaging tests, such as CT or MRI with angiography are done first to see if the cancer can be removed completely. Still, sometimes during surgery the cancer is found to be too large or spread too far to be removed, and the surgery has to be cancelled.

More than 4 out of 5 people in the United States with liver cancer also have cirrhosis. In someone with severe cirrhosis, removing even a small amount of liver tissue at the edges of a cancer might not leave enough liver behind to perform essential functions. People with cirrhosis are eligible for surgery only if the cancer is small and they still have a reasonable amount of liver function left. Doctors often assess this function by assigning a Child-Pugh score (see the section “How is liver cancer staged?”), which is a measure of cirrhosis based on certain lab tests and symptoms. Patients in class A are most likely to have enough liver function to have surgery. Patients in class B are less likely to be able to have surgery. Surgery is not typically an option for patients in class C.

Possible risks and side effects: Liver resection is a major, serious operation that should only be done by skilled and experienced surgeons. Because people with liver cancer usually have liver problems besides the cancer, surgeons have to remove enough of the liver to try to get all of the cancer, yet leave enough behind for the liver to function adequately.

A lot of blood passes through the liver, and bleeding after surgery is a major concern. On top of this, the liver normally makes substances that help the blood clot. Damage to the liver (both before the surgery and during the surgery itself) can add to potential bleeding problems.

Other possible problems are similar to those seen with other major surgeries and can include infections, complications from anesthesia, blood clots, and pneumonia.

Another concern is that because the remaining liver still has the underlying disease that led to the cancer, sometimes a new liver cancer can develop afterward.

Liver transplant

When it is available, a liver transplant may be the best option for some people with small liver cancers. At this time, liver transplants can be an option for those with tumors that cannot be removed with surgery, either because of the location of the tumors or because the liver is too diseased for the patient to withstand removing part of it. In general, it is used to treat patients with small tumors (either 1 tumor smaller than 5 cm across or 2 to 3 tumors no larger than 3 cm) that have not invaded nearby blood vessels. It can also rarely be an option for patients with resectable cancers (cancers that can be removed completely).

According to the Organ Procurement and Transplantation Network, about 1,200 liver transplants were done in people with cancer in the liver in the United States in 2011, the last year for which numbers are available. In most cases, the patients had liver cancer but some had bile duct cancer.

With a transplant, not only is the risk of a second new liver cancer significantly reduced, but the new liver will function normally.

Unfortunately, the opportunities for liver transplants are limited. Only about 6,000 livers are available for transplant each year, and most of these are used for patients with diseases other than liver cancer. Increased awareness about the importance of organ donation is an essential public health goal that could make this treatment available to more patients with liver cancer and other serious liver diseases.

Most livers for transplants come from people who have just died. But in recent years, a small number of patients have received part of a liver from a living donor (usually a close relative) for transplant. The liver can regenerate some of its lost function over time if part of it is removed. Still, the surgery does carry some risks for the donor. Less than 250 living donor transplants are done in the United States each year. Only a small number of them are for patients with liver cancer.

People needing a transplant must wait until a liver is available, which can take too long for some people with liver cancer. In many cases a person may get other treatments, such as embolization or ablation (described in following sections), while waiting for a liver transplant. Or doctors may suggest surgery or other treatments first and then a transplant if the cancer comes back.

Possible risks and side effects: Like partial hepatectomy, a liver transplant is a major operation with serious risks (bleeding, infection, blood clots, complications from anesthesia, etc.). But there are some additional risks after this surgery.

People who get a liver transplant have to be given drugs to help suppress their immune systems to prevent their bodies from rejecting the new organ. These drugs have their own risks and side effects, especially the risk of getting serious infections. By suppressing the immune system, these drugs might also allow any remaining liver cancer to grow even faster than before. Some of the drugs used to prevent rejection can also cause high blood pressure, high cholesterol, diabetes, can weaken the bones and kidneys, and can even lead to a new cancer.

After a liver transplant, regular blood tests are important to check for signs of the body rejecting the new liver. Sometimes liver biopsies are also taken to see if rejection is occurring and if changes are needed in the anti-rejection medicines.