Definition and Overview
Hepatectomy is the surgical resection or the complete removal of the liver. While this procedure can also be performed to “harvest” healthy liver tissue, it is mostly performed to remove diseased parts of the organ to treat certain conditions such as benign hepatic neoplasms and cancer.
Who Should Undergo and Expected Results
A liver resection is often recommended for patients suffering from malignant or benign hepatic neoplasms, including the following:
Hepatocellular adenoma. Also known as a hepatic adenoma, this is characterised by an uncommon growth in the liver. This is often linked to the extended use of hormonal contraceptives with high levels of estrogen content. Patients with this condition may experience abdominal pain, feel a palpable mass in the area near the liver, and bleeding, which might lead to excessive sweating, hypotension, and tachycardia. However, many patients with hepatocellular adenoma do not feel any noticeable sign or symptom. While this condition is best treated with a liver resection procedure, extreme care must be observed during the procedure to prevent rupture of the adenoma.
Hepatic hemangioma. This is the most common type of hepatic tumours. A hemangioma in the liver is made of dilated blood vessels, and can be a birth defect. However, it is important to note that hepatic hemangioma can occur at any point in a patient’s life, but patients between 30 and 50 years old are more susceptible to it. Women develop these benign tumours more often than male patients, with their tumours often larger than those found in men. While this type of liver tumour is not cancerous, some patients experience signs and symptoms ranging from anemia, a palpable growth in the abdomen, abnormal organ function, and signs of heart failure. Hepatectomy is not the first line of treatment for this condition—the patient might be prescribed to undergo an embolization (or the insertion of a biocompatible material into the blood vessel in the liver feeding the hemangioma), a ligation (tying off an artery in the liver), and medication to address heart failure symptoms before being prescribed a liver resection.
Focular nodular hyperplasia. This hepatic tumour is benign, and the second most common type of growth in the human liver. A focular nodular hyperplasia seldom causes symptoms, rarely grows larger, rarely bleeds, and never develops into a cancerous tumour. In the past, this type of tumor was often resected because diagnostic technologies had difficulty distinguishing it from hepatic adenoma.
Metastases to the liver. This condition is caused by cancer affecting other parts of the body spreading into the patient’s liver. Once cancer starts invading the cells of the liver, the patient might experience nausea, have jaundice (a yellowish pigmentation of the skin, the whites of the eyes [also known as sclera], and other mucus membranes), and have an enlarged liver. When the metastasis to the liver is caused by colorectal cancer, the prognosis for the patient is positive.
Hepatocellular carcinoma. This condition is known to be the most common type of liver cancer, and is often secondary to cirrhosis (caused by alcoholism and other factors) and viral hepatitis infection (hepatitis B or C). A liver resection is typically prescribed to remove the tumour, including surrounding liver tissue while preserving healthy liver tissues for normal organ function. Research shows that a hepatectomy has high success rates for patients with hepatocellular carcinoma, but only ten to 15 percent of all patients are suitable for this procedure. In patients with cirrhosis, morbidity and mortality rates are quite high.
Hepatectomy combined with systemic or regional chemotherapy or biological therapy produce optimal results.
How Does the Procedure Work?
The liver resection surgery is performed under general anaesthesia, which means that the patient is asleep during the whole duration of the surgery and will not feel any pain. Small incisions are made in the abdomen, with the surgeon gaining access to the organ through laparotomy. Modern surgical techniques include an anterior approach, in which the surgeon performs a simpler liver hanging maneuver.
In many cases, the surgeon will follow the natural segments of the organ as defined by the Couinaud classification, with the resections matching these segments. There are also non-anatomic liver resection techniques, which remove wedges or irregular segments of the organ. It is important to note that anatomic resections, or following the natural segments of the liver, is preferred by many surgeons as it minimizes the risk of biliary fistula and bleeding.
As soon as the surgeon gains access to the organ, the liver is freed from the long fibers connecting it to the rest of the body. Segments of the liver will soon follow. The surgeon will need to exercise care to prevent rupture of any important blood vessels, which can lead to hemorrhage. The surgeon can use an electric lancet to make a superficial burn on the organ to mark the segments to be removed. The surrounding connective tissues will then be removed and clamped before the segments marked for removal are excised. The small incisions will then be closed.
The patient will need to stay in the hospital for monitoring. In many cases, the liver will begin to heal itself and grow back after a couple of weeks.
Possible Risks and Complications
Possible risks and complications during and after the procedure include:
- Perforation of nearby organs and structures
- Urinary tract infection
- Postoperative fevers
- Formation of blood clots in the legs, which can travel up to the lungs and cause pulmonary embolism
American College of Surgeons
- National Cancer Institute
- International Journal of Gastrointestinal Cancer
- United States National Library of Medicine