Question

Understanding Liver Cancer Surgery!

Dr.Bipin Vibhute · Accepted Answer

What is Liver Cancer Surgery?

The liver is an extremely instrumental organ in the human body. It not only aids in proper digestion but also fights outside infections that threaten the immune system in the body. Liver cancer and failure of it to perform its assigned functions are extremities of diseases faced by the liver. Hence, to avoid further complications such as spread of cancer, liver cancer surgery is the best option available.

Why is Liver Cancer Surgery Required?

Liver cancer surgery usually is for life-saving purposes. In some cases, cancer is totally removed from the liver, but in some cases, surgery helps in making the patient survive for longer than expected. Also, surgery is useful in stopping the advancement of cancer to the remaining parts of the body from liver. Depending on the condition, doctors decide the type of surgery method to be adopted.

Pre-operative Preparation

When doctors come to a conclusion that surgery is the only respite left for treating cancer, the surgery decision is confirmed for the patient. There are certain diagnostic tests that the patient is made to undergo before surgery. Few of them are as follows:

Biopsy: Entails excision of a small amount of liver tissue for analysis. It is ordered so that the extent of progression of the tumor before the surgery is known.
ECG: An electrocardiogram is ordered before the surgery for examining the overall functioning of the heart.
CBC: A Complete Blood Count (CBC) provides an idea of the platelet count along with red and white blood cell count. A difference in the CBC from the normal range may alert the doctor about any possible infections and so he/she may reschedule the surgery totally.
Blood sugar testing: Blood sugar levels are also needed to check before the actual surgery.
Following given are the instructions patient needs to follow once surgery date is decided. The date for surgery is also then scheduled.

Day Before Surgery

Having to undergo surgery for liver cancer or for that matter any other cancer is a very distressing time for the person and his family members. Therefore having an idea as to what goes into the preparation stage can brace the person for taking precautions and then going in for the surgery. Following given are some other steps you can take to help ensure a better surgical outcome on your end:

Rest and diet: Make sure to get plenty of rest. A healthy diet can help prepare your body for surgery.
Smoking: You need to stop smoking at once when you get a go ahead for the surgery. Smoking can really delay recovery and slow the healing process. Lung complications can also be an after effect of the surgery.
Pre-surgery tests: The doctor will make you undergo few requisite tests before surgery to know the levels of your physical well-being.
Instructions: It is better to ask your doctor beforehand about the things necessary for looking after the incisions post surgery and the dosage of medication. Follow these instructions carefully. Know which side effects after surgery are normal and which may be signs of a complication.
Leg exercises: The physiotherapist will teach you few leg exercises you need to immediately start doing post surgery for preventing formation of blood clots in your legs along with the medication prescribed.
Breathing exercises: Knowing few exercises for breathing correctly post surgery is necessary to prevent contracting lung infections.
Procedure Day

The probability of getting back to a fit and fine body like before depends on many factors like - the progression and growth of the tumors to other parts of the body, whether the person is having cancer for the first time, or whether his earlier cancer has relapsed. It also has got a lot to do with the person's general health, whether he has any other liver condition, and lastly if the person is a likely candidate for liver transplant if the cancer is not possible to go away by removal of the affected part of liver.

While the above mentioned were the types under which cancer is classified and the chances of recovery, the line of treatment varies according to patient. There are few types of standard treatments that are used for treating any person suffering from liver cancer. They are as follows:

Methods/Techniques of Liver Cancer Surgery

Liver Resection: Surgery for resection of the liver to remove affected parts is called liver resection. The surgery for it is also referred to as partial or full hepactectomy. Surgical resection of liver is feasible because liver is an organ that has regenerative capacity. A liver transplant becomes compulsory when the liver function is very poor and not up to the mark. At such times, removing the affected portion of liver would only result in liver failure, transplant from a donor is helpful. In such liver cancer cases, the old liver is removed and fitted with a new one.

Minimally-Invasive Laparoscopic Liver Tumor Resection A laparascopic procedure is decided based on the size and location of the tumors. In this minimally invasive approach of surgery for liver cancer. One or multiple incisions are made for being able to insert the laparascope. The incisions enable the doctor to insert the cameras and surgical instruments for performing the resection surgery. The minimally-invasive surgery involves faster recovery, less blood loss and lesser postoperative pain, fewer and smaller scars as compared to an open surgery. Depending on your condition, you may need only a short hospital stay.

Cryosurgery: This technique commences with the patient getting a general anesthetic injected. A thin metal probe then freezes the tumor with the help of cold gases that destroy the cancerous cells. The probe is inserted through the abdominal skin during this technique which is used for treating liver cancer. This method is also called as Percutaneous technique. The metallic probe may sometimes be inserted in the abdominal cavity for operating on the tumor. This technique is termed as intra-abdominal surgery.

Liver Transplant: A liver transplant is another surgical technique for elimination of liver cancer from the body. This method is not advisable for people suffering from bile duct cancer. Also, only people with one or multiple small liver tumors are considered for this treatment. It involves removing the entire liver for eventually replacing it with a healthy liver taken from a donor. People suffering from liver cancer and those who qualify for a liver transplant need to wait for a long time for getting the correct donor. As a result, cancer continues to grow and at that time, tumor ablation therapy is considered suitable for the patient till time being.

Isolated Liver Perfusion: This method is only used in rare liver cancer cases wherein the cancer is failing to respond to other surgical techniques. The name comes from, the procedural step wherein highly concentrated chemotherapeutic drugs are infused into the liver. As a result, hepatic circulatory system is separated from other sources that supply blood to the body.

Other than the above treatments, targeted therapies, chemotherapy, palliative treatment and radioembolization are used for treating patients suffering from liver cancer. That is decided of course on the basis of type, staging and progression of tumors.

Post Procedure

The surgery duration depends on the complications and progression of the liver cancer inside. The time will differ from patient to patient.

Recovery area - You will be moved to the recovery area from the operation theater once your surgery is done.
IV-drip - An intravenous fluid drip is connected to a vein in your neck for giving you fluids and medicines.
Oxygen mask - An oxygen mask is attached externally to your body to maintain a constant oxygen supply.
Catheter - A catheter is left in your bladder for proper urinary functioning for 2-3 days from the surgery. Thereafter, the patient is kept in a High Dependency Unit to be kept under observation for few more days till he is declared fit to go home.
Do's and Don'ts... Post-Liver Cancer Surgery

Following listed are the recovery tips to be followed in the period post undergoing any of the above treatments listed for liver cancer of any stage.

Incision care - The dressing placed to seal the incisions used during procedure need to be kept clean and infection free.
Fatigue - It is normal to feel tired and upset over the few days post surgery. Memory retention and concentration is also very difficult; let it pass.
Plenty of rest - You should allow yourself plenty of rest once you get the discharged from the hospital.
Heavy physical activities - Avoid lifting heavy objects and attempting any pressuring tasks anywhere in the house.
Driving - Avoid driving your vehicles for at least 6 weeks after surgery.
Return to work - 3-4 weeks time is enough for cooling off the effects of surgery and returning to work thereafter. However, your doctor can be the best judge to advice about getting back to work.
Alcohol - You should stay away from alcohol consumption for at least 6 weeks after surgery.
Diet - It is advisable that you avoid eating hard or crunchy foods in the early part of your recovery period. Prefer juices, soups and related fluids that will keep you hydrated as well as energetic.
Frequency of food intake - The gaps between food intake in the entire day should not be too much. This is so as to not disturb the liver functioning further more, as the functioning post surgery is obviously disturbed.
Adequate nutrition - Make sure to include a balanced diet and nutrition categories in your everyday food post surgery. This is helpful not only in improving liver functioning but also in promoting regeneration of liver post any surgery for cancer elimination.
Laxatives - You may be requiring laxatives for the first few days to have a smooth bowel movement. Emphasize on eating specific fruits like kiwifruit and prunes to clear the bowel properly without medication.
Risks and Complications

There are few complications associated with liver cancer surgeries mentioned above.

Liver Resection Risks

Bleeding post surgery is a common complication. Also, development of blood clots in legs post operation which is also known as deep vein thrombosis is another possibility. Infections developing at the site of surgery and leakage of bile from liver are 2 other complications coming with the liver resection procedure.

Liver Transplant Risks

Liver rejection is the most common side effect. It happens because the transplanted liver is relatively new to the body and also to the immune system. As a result, diarrhea, reduced energy levels, yellowing of skin and fever with high temperature are experienced by the patient. Also, there are likely side-effects because of medicines used during transplant that may cause high cholesterol, high blood pressure, weakened bones and kidneys etc.

Cryosurgery Risks

Cryosurgery done for treating the liver cancer may cause hemorrhage, infection, damage to major blood vessels and bile ducts and at times also relapse of the cancer

This page included information on liver cancer surgery types and every detail a patient ought to know about what happens during, before and after surgery. The treatment method; whether surgical or non-surgical, depends on the age, grade of tumor, overall health and extent of progression of the tumor in the person's body. It is highly recommended that timely action is taken post consultation with your doctor and instruction are followed for fast recovery.

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