Liver resection/hepatectomy

The follow-up appointment date may vary depending on the individual and the condition. The surgeon may ask you to visit the hospital four to six weeks after the surgery followed by regular clinic visits, blood tests and imaging tests for up to three years to assess your condition.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

Liver resection surgery/hepatectomy is a crucial surgical procedure in which the healthcare team removes a diseased/affected portion of the liver, and sometimes gall bladder.

This surgery is mostly performed for managing cancer in the liver that has either originated in the liver or gallbladder or when the cancer has spread to the liver from another organ or regions in the body.

Liver is a cone-shaped organ placed below the rib cage, on the right side of the abdomen. It consists of two lobes – a right lobe and a left lobe and performs various vital functions in the body, such as the production of bile that helps in digestion. However, your body can survive with even one-third part of your liver. Moreover, the remarkable regenerating capacity of liver enables the growth of a surgically removed portion of the liver within three months. The surgery in which the left side of the liver is removed is known as left hemi-hepatectomy, whereas right hemi-hepatectomy involves the surgical removal of the right side of the liver.

The gallbladder is a small organ situated adjacent to the right side of the liver. It stores excess bile produced by the liver. If required, this organ is also removed during right hemi-hepatectomy.

A surgeon will recommend this surgery if you have cancer in the liver that has spread from other body parts (secondary metastases), cancer that has originated in the liver (primary hepatic malignancy) or non-cancerous tumour in the liver (benign hepatic tumour).

These conditions may cause the following symptoms:

• Unexpected loss of weight 
• Nausea or vomiting
• Itching
• Jaundice
• Enlarged liver or enlarged spleen
• Swelling in the abdomen
• Reduced appetite

Liver resection is also considered in individuals who have a large part of their liver affected by a trauma.

A surgeon may not perform this surgery if you have any of the following conditions:

• Chronic renal failure (kidney malfunction)
• Congestive heart failure
• Tumour in the either of the two blood vessels of the liver: main portal vein or inferior vena cava

A surgeon will decide whether you are an eligible candidate for the surgery based on factors such as the position of the tumour, the spread of cancer, the status of your liver function, and how much of the liver has to be removed to remove all of the cancer. He/she will ask you to visit the hospital for a pre-operative assessment, wherein your medical history will be reviewed and the following examinations will be done:

• Physical examination
• Blood tests
• Electrocardiogram (to evaluate the electric signals of the heart)
• Chest x-ray

The following are some other preparations that are needed before a liver resection surgery:

• You will be requested to disclose the list of all the present and previous medications, including herbal medicines and over-the-counter drugs.
• You will be asked to stop smoking as soon as possible to avoid delay in the recovery process.
• The surgeon will also suggest you to perform some gentle exercises for a few days before being admitted to the hospital for the surgery. These will help you stay in shape for the procedure.
• You will be given instructions for fasting before the surgery. 
• The surgeon will inform you about emptying your bowels before the surgery as it could help in avoiding postoperative constipation.
• You will be asked to minimise alcohol intake and lead a healthy lifestyle to maintain better overall health for the surgery.

You will be asked to admit yourself in the hospital one day (either afternoon or evening) before the surgery. The surgeon will instruct you to avoid eating anything for about six hours and drinking for two hours before the scheduled time of the surgery. You will be asked to sign a consent form, which will help you understand the recommended type of surgery and its advantages, disadvantages, as well as the risks of the procedure. The form will provide your consent to the surgeon to perform the procedure on you.

An anesthesiologist will administer a combination of general anaesthesia and epidural anaesthesia to you. General anaesthesia will put you in a deep sleep for the duration of the surgery, whereas epidural anaesthesia (administered through a tube in the lower back) will control pain in the operated area. A breathing tube will be inserted into your throat to help you breathe during the procedure. The surgeon may perform the liver resection surgery by either of the two methods:

• Laparoscopic surgery: For this method, the surgeon will make three to seven small incisions in your abdomen. He/she will then insert several surgical instruments, such as a camera through these incisions to cut/remove the diseased part of your liver.
• Open surgery: For this surgery, the surgeon will make a horizontal incision below your rib cage.

As compared to open surgery, laparoscopic surgery is associated with less pain and a faster recovery.

The surgery may take anywhere between 6 and 15 hours for completion. Following the surgery, you may need to stay at the hospital for approximately three to seven days. The following events can happen during your stay at the hospital:

• You may have a soft, flexible tube, known as a catheter, inserted in your urinary bladder after the surgery to drain out urine. This catheter is usually removed 24 hours after the surgery.
• You may also have tubes inserted at your operation site to drain out any collected fluid.
• You will not be given anything to eat or drink anything immediately after surgery. Your doctor will put you on a liquid diet on the day after the surgery. You will be moved to a regular diet in one to two days. If you are unable to tolerate the intake of food, then you will be given medicines and fluid through an intravenous line.
• The surgeon will give you pain medications for controlling pain. If you are not able to tolerate food by mouth, then the pain control medications will be given either through an epidural catheter (a tube inserted into your lower back) or through an intravenous line. Oral medications will be given to you once you start eating food on your own.
• You will be encouraged to get out of the bed frequently (minimum three times a day) and slowly increase your activity level. This will help in speeding up the recovery process.
• The surgeon will ask you to perform breathing exercises by using a device known as a spirometer. This will help to prevent lung infections such as pneumonia. 

Your discharge from the hospital will be based on factors such as stability of your vital signs, pain control and whether you are able to eat normally and get out of bed with minimal assistance.

Before you are discharged from the hospital, you will be given instructions on how to take care of yourself at home as follows:

• Physical activities: Do not do any strenuous activities such as lifting heavy objects/materials for at least three months after the surgery. You can start with slow-paced walking during the initial few weeks post-surgery and gradually increase your speed and distance.
• Diet: You will be recommended a high-protein diet during the recovery period. You should eat your meals at regular intervals with healthy snacks in between meals.
• Alcohol: Refrain from drinking alcohol for three months after the surgery since the liver will be regenerating and repairing itself during this period. You may consume alcohol after this period in moderation; however, it would be better to stop drinking alcohol permanently. Read more: Effects of alcohol on the body
• Driving: You may drive six to eight weeks after the surgery; however, you must not drive in case you are feeling any discomfort.
• Work: Your doctor will decide whether you can resume your work based on your recovery and whether you require additional treatment. Most people can return to work 4-12 weeks after the surgery.
• Sex: Once you feel comfortable performing normal daily activities, you can restart your sex life.

Approximately three months are required for complete recovery after the surgery. Liver resection surgery is the most effective treatment option to remove liver cancer. A successful liver resection surgery increases your chances of survival beyond five years by 25-45%.

When to see the doctor?

You should contact or inform the surgeon immediately if you observe any of the following symptoms after the surgery:

• Constant sharp pain
• Jaundice
• Fever
• Inability to eat food as usual or constant stomach issues
• Redness or pain at the operation site
• Smelly discharge from the operation site
• Excessive fatigue

The complications associated with this surgery are as following:

• Infection
• Excessive loss of blood
• Pneumonia
• Formation of blood clots
• Jaundice
• Complications from anaesthesia such as breathing problems or damage to the lungs
• Leak of bile juice 
• Liver failure
• Emergence of new liver cancer