Surgical Treatment

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Surgical Treatment for Liver Cancer

Two types of surgeries can be performed as treatment for liver cancer:

If all cancer in the liver is successfully removed, you will have the best outlook.

Liver Resection

Surgery to remove part of the liver is called as liver resection. It is also known as partial hepatectomy. This operation is considered for a single tumor that has not grown into blood vessels. It is only an option in patients with good liver function who are healthy enough for surgery.

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.

Most patients 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. Hence, people with cirrhosis are eligible for surgery only if the cancer is small and they still have a reasonable amount of liver function left.

Patients in early stage are most likely to have enough liver function to have surgery.

Liver resection is a major, serious operation that should only be done by skilled and experienced surgeons. Because people with liver cancer usually have other 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 Transplantation

Liver transplant may be the best option for some people with small liver cancers. Liver transplants can be an option for those with tumors that cannot be removed by liver resection, 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 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).

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

Increasing 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 used for transplants in India are Living donor liver transplantation (LDLT). Patients receive 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.

Occasionally livers used for transplants come from people who have just died. This type of liver transplantation is known as deceased donor liver transplantation (DDLT). 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.

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 are 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 liver cancer that had spread outside of the liver to grow even faster than before. Some of the drugs used to prevent rejection can also cause high blood pressure, high cholesterol, and diabetes; can weaken the bones and kidneys; and can even lead to a new cancer.

After a liver transplant, regular blood tests are done 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.

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