Liver resection

Liver resection, also called hepatectomy, is surgery to remove liver tissue. The amount removed and the way the surgeon operates are separate choices. For hepatocellular carcinoma, a primary liver cancer, approaches include open surgery, laparoscopy through small incisions, and robot-assisted surgery. Minimally invasive liver surgery requires specific surgical skills.

The extent of surgery also matters for perihilar cholangiocarcinoma, a cancer of the bile ducts near the liver. A review of surgery for this cancer found no clear benefit from routinely choosing a more extensive liver resection over a less extensive one. Preserving more liver tissue may be considered when this does not compromise cancer removal.

Liver resection is a treatment for liver cancer, but the treatment choices differ by cancer type. For hepatocellular carcinoma that cannot initially be removed, surgery may become possible in selected patients after treatment intended to make it operable. Better survival in these selected patients reflects both their response to treatment and their suitability for surgery, rather than the effect of surgery alone.

For perihilar bile duct cancer, liver transplantation is another possible approach for highly selected patients within programmes that use treatment and selection before transplantation. For the rare combined hepatocellular-cholangiocarcinoma, which has features of both liver-cell and bile-duct cancer, transplantation has also been studied as an alternative to resection in carefully selected patients. These are diagnosis-specific options, not interchangeable treatments for every liver tumour.

For hepatocellular carcinoma, a review of 69 studies involving 13,257 patients found no statistically significant difference in death within 90 days between robotic, laparoscopic and open liver resection. Most of the studies were retrospective, meaning they looked back at patients already treated, so this does not establish that the approaches are equally safe for every patient.

For perihilar bile duct cancer, a separate review included 768 patients: 265 underwent transplantation and 503 underwent resection. Survival at five years, including survival without the disease returning, was higher in the transplantation group. However, the groups were highly selected, the studies were retrospective, and transplant results often started counting survival only after transplantation rather than from entry into the treatment pathway. This comparison therefore cannot show what would happen if every patient eligible for resection chose transplantation instead.

Important risks after liver resection include bleeding, leakage of bile and liver failure, when the liver cannot carry out its functions adequately after surgery. Risk depends on the patient’s health, the disease and liver function. Blood loss and the possible need for a transfusion are also important considerations. Before surgery, blood-management planning includes assessing transfusion risk and investigating and treating anaemia, a low level of haemoglobin in the blood.

Quality monitoring for liver surgery includes bile leaks, serious complications, unplanned further procedures within 90 days and death within 90 days. These are useful topics to discuss with the surgical team when reviewing its results.

Preparation before surgery and getting moving early afterwards are important parts of care around liver resection. Prehabilitation means preparing your physical condition before the operation. Care planning also addresses nutrition. Recommendations support early movement after surgery and advise against routinely using drains in every patient.