Liver Resection
A liver resection is a surgical procedure in which a portion of the liver is removed to treat hepatocellular carcinoma (liver cancer), and liver tumors or cysts that may be benign or malignant. The most common reason for a liver resection is to remove a colorectal metastasis (a tumor that has spread from a primary source.) Success of the resection varies based on the size of the tumor as well as the location.
Prior to the procedure, a thorough patient history will need to be obtained, noting any use of anticoagulant medications such as Aspirin, Plavix, Coumadin, or Heparin or insulin therapy. Cessation of these agents may be required per instruction of the physician for several days prior to the procedure or replaced with other medications.
A liver resection can be performed by open incision or laparoscopic procedure, both requiring general anesthesia in a surgical setting and 2-5 hours of surgical time. The amount of liver to be removed will determine which procedure is used. The liver is divided into 8 sections, and up to one-half of the liver may be removed with successful results.
The Procedure
An open incision liver resection is begun with a chevron (V-shaped) incision extending from the right side of the upper abdomen to the lower abdomen. At this time the surgeon will inspect the liver, using an implement to divide the liver parenchyma (functional tissue) from the diseased portion, removing healthy tissue on either side to ensure excision of the affected area. The area will be treated for bleeding, and the incision will be sewn closed with an inpatient stay of 5-7 days postoperatively.
A laparoscopic procedure is used when there is a smaller area of the liver requiring excision. There are 3-4 small incisions made to abdomen and the abdominal cavity is filled with carbon dioxide to allow for tool placement and visualization of the area. The affected area is identified and removed, treated for bleeding, and the incision sites sutured. Recovery time is approximately 2-3 days in an inpatient setting.
Risks and Complications
The largest potential side effect for either procedure is bleeding, with postoperative patients receiving frequent monitoring. The pulmonary system is also monitored for symptoms such as pleural infusion (fluid around the lungs) and atelectasis (lung collapse), and is more likely in patients with lung deficiencies. Infection, while a valid possibility, is usually rare.