Liver resection at Leeds Hospital

What conditions does liver resection treat? 

The most common reason for liver resection is cancer that has spread to the liver from somewhere else in the body, such as from the bowel. It is also used to treat cancers that start in the liver itself, including Hepatocellular Carcinoma (the most common type of primary liver cancer) and Cholangiocarcinoma (cancer affecting the bile ducts, the tubes that carry bile from the liver to the intestine). 

Liver resection can also treat cancer of the gallbladder (a small sac attached to the liver that stores bile), and some non-cancerous (benign) conditions, including liver cysts (fluid-filled sacs in the liver) and certain benign tumours. 

Occasionally, when it is not possible to confirm the exact cause of a liver problem before surgery, removing the affected area can both treat the condition and help make a definite diagnosis. 

What are the benefits? 

The aim of liver resection is to remove all the cancer from your liver, giving you the best possible chance of a long-term cure.  

Your liver has a strong ability to recover after surgery. Your body can usually tolerate the removal of up to two-thirds of the liver, and the remaining tissue typically grows back to close to its original size within 3 months of the operation. In many cases there are no long-term side effects once the liver has fully recovered. 

Types of liver resection 

There are two main surgical approaches, and your team will recommend the one that is safest for your situation. 

Open surgery involves a cut (incision) just below the ribcage and across the upper right side of the abdomen, giving the surgeon a direct view of the liver. This approach is used for more complex procedures and typically takes 3 to 6 hours. 

Keyhole surgery (laparoscopic surgery) uses four to six small cuts in the abdomen. A tiny camera and surgical instruments are inserted through these cuts, so there is no large wound. Recovery is generally quicker as a result. Robotic keyhole surgery is also available and uses a three-dimensional camera view, which can be helpful in more technically challenging cases. 

The amount of liver removed depends on the size and position of the tumour. Taking out more than three of the liver's segments is classed as a major resection; removing a smaller section is a minor resection. 

Where the healthy part of the liver is too small to work safely after surgery, your team may first recommend a procedure called portal vein embolisation (PVE). This blocks blood flow to the diseased part of the liver and encourages the healthy part to grow larger. PVE is usually done 4 to 5 weeks before the main operation. 

For some patients, surgery is planned in two stages, with time allowed between operations for the liver to grow. 

Before your operation 

Your liver surgeon, X-ray doctor (radiologist) and cancer specialist (oncologist) will review your test results together before deciding whether surgery is right for you. 

You will also attend a pre-operative assessment clinic. This appointment takes around 2 hours and typically includes: 

• A chest X-ray 
• An ECG (a test that checks your heart rhythm and electrical activity) 
• Blood tests to measure how well your liver is working 
• Imaging such as a CT scan or MRI to map the liver in detail 

Some people also need a cardiopulmonary exercise test (CPET). This involves pedalling an exercise bike while measurements are taken to check how your heart and lungs respond to effort. 

Steps you can take to support your recovery: 

• If you smoke, stop as soon as you know you need the operation 
• Try to stay as active as possible beforehand; even gentle walking helps 
• Arrange support at home for when you return, especially if you live alone 
• Bring a list of all your medications to the pre-operative appointment, including vitamins or herbal remedies 

You will be given written information about the Enhanced Recovery After Surgery (ERAS) programme, which explains how your care team will support you to recover as quickly as possible. 

What happens during the procedure? 

Liver resection is carried out under general anaesthetic (medicine that sends you fully to sleep). For open surgery, you will usually also have an epidural: a thin tube placed into your back before you go to sleep that delivers pain-relieving medicine directly to the nerves. The epidural typically stays in place for 3 to 5 days after the operation. 

Your surgical team will: 

1. Make the incisions: one larger cut for open surgery or four to six small keyhole cuts 
2. Use an ultrasound scan during the operation to check for any small tumours that were not visible before surgery 
3. Remove the diseased section of liver, along with a border of healthy tissue around any tumour 
4. Check the remaining liver carefully before closing the wound 

About 1 in 6 people need a blood transfusion during or after the operation. 

Occasionally, problems are found during surgery that could not be seen beforehand, such as cancer that has spread further than the scans suggested. If all the cancer cannot be safely removed, the surgeon will not remove any of it. 

Recovery from liver resection 

In hospital 

After the operation, you will be taken to a recovery unit. For a major resection, this is usually an intensive care unit (ICU) where nurses can monitor you closely. Most people move back to the specialist ward the following day. 

When you wake up, you will have a number of temporary tubes in place. These commonly include: 

• A drip into a vein to give you fluids and medicines 
• Wound drains to remove any fluid from around the operation site 
• A tube through your nose into your stomach (nasogastric tube) to prevent nausea 
• A tube into your bladder (catheter) to measure how much urine you pass 
• The epidural tube in your back for pain relief.

Pain during the first week is normal. Your team will keep it under control with the epidural or a patient-controlled pump, where you press a button to give yourself a dose of pain relief when you need it. Tell your nurse or doctor straight away if your pain is not well controlled. 

Most people start eating and drinking the day after surgery, beginning with small sips and building up gradually. A physiotherapist will help you with breathing exercises and encourage you to start moving as early as possible. Getting up and walking, even short distances, reduces the risk of blood clots and helps the liver recover. 

How long you stay in hospital depends on the type of surgery and how your recovery progresses. For keyhole surgery involving a smaller resection, some sources suggest discharge may be possible after 2 to 3 days, with a larger keyhole resection around 4 to 5 days. Open surgery or more extensive procedures may involve a stay of 5 to 7 days or longer. Your team will give you a realistic expectation based on your specific situation. 

At home 

Significant tiredness is very common for several weeks after you go home and can continue for a few months. Rest when you need to, eat well, and build your activity up gradually. 

For the 4 to 6 weeks after your operation, avoid heavy lifting and strenuous activities such as gardening or vacuuming. Take your prescribed medicines as directed, including any painkillers. 

You will have follow-up appointments to check your recovery and look for any signs that further treatment may be needed. 

Risks and complications 

Liver resection is a major operation and carries risks.  Your surgeon will talk through the specific risks with you before you consent to surgery. 

Possible complications include: 

• Bleeding: About 1 in 6 people need a blood transfusion during or after the operation 
• Chest infection: Related to the anaesthetic; some people need short-term breathing support in intensive care 
• Wound infection 
• Blood clots in the legs 
• Bile leak: Bile (a fluid made by the liver) may leak from the cut surface. This usually heals on its own but can sometimes need a further procedure to stop it 
• Jaundice: A temporary yellowing of the skin and eyes that can occur if the remaining liver struggles to process bile. It usually improves as the liver grows and recovers. A build-up of fluid in the abdomen and legs can happen alongside jaundice.

Contact your surgical team promptly if you notice any of these symptoms after going home.

Frequently asked questions

Will my liver grow back after surgery?

Yes. The liver is one of the few organs that can grow back after part of it is removed. The remaining tissue usually grows back to close to its original size within 3 months of the operation, provided it is healthy.

How much of my liver can be removed?

Your body can usually tolerate the removal of up to two-thirds of the liver. If your liver already has existing disease or damage, your surgeon may only be able to remove a smaller proportion safely.

How long does a liver resection take?

Open surgery typically takes 3 to 6 hours. Keyhole surgery is generally shorter, though the exact time depends on the extent of the resection and your individual anatomy.

What is the difference between open and keyhole surgery?

Open surgery involves a single, larger cut that gives the surgeon a direct view of the liver and is best for complex procedures. Keyhole surgery uses four to six small cuts with a camera and instruments, and generally means a faster recovery. Robotic keyhole surgery is available at some specialist centres and provides a three-dimensional view. Your surgeon will recommend the approach that is most appropriate for your case.

How long will I be in hospital?

This varies depending on the type of surgery and your recovery. Keyhole surgery for a smaller resection may allow you to go home within a few days, while open surgery or more extensive procedures may mean a stay of 1 to 2 weeks. Your team will give you a clearer estimate before the operation.