Hepatic Resection
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Hepatic Resection

(Resection, Hepatic; Liver Resection; Resection, Liver)

Pronounced: heh-PA-tik ree-SEK-shun

En Español (Spanish Version)

Definition

Hepatic resection is surgery to remove a portion of the liver.

Reasons for Procedure

Hepatic resection is most often used to treat cancer in the liver. It can also be done for the following reasons:

  • Treat other liver tumors
  • Treat cancer that has spread to the liver (most often seen in patients with colon cancer)
  • Liver transplant donation
  • Treat trauma to the liver

Liver Cancer Due to Liver Disease (Cirrhosis)

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Possible Complications

If you are planning to have a hepatic resection, your doctor will review a list of possible complications, which may include:

  • Excess bleeding
  • Reaction to anesthesia
  • Infection
  • Nausea and vomiting
  • Low blood sugar
  • Liver failure

Factors that may increase the risk of complications include:

  • Smoking
  • Diabetes
  • Pre-existing liver disease (eg, cirrhosis, cholestasis)
  • Drinking large amounts of alcohol, either before or after surgery

Long-term side effects are uncommon. This is because the liver is able to regrow and function normally within a few months. But, this can happen more slowly in older patients.

Discuss these risks with your doctor before surgery.

What to Expect

Prior to Procedure

Before surgery:

  • You may be given chemotherapy to shrink liver tumors.
  • You may meet with a doctor who specializes in liver surgery.
  • Your doctor may do tests to determine the exact location of the tumors:
    • CT scan—a type of x-ray that uses a computer to make pictures of structures in the abdomen
    • PET scan—a test that uses a small amount of radiation to locate areas in the body with abnormal metabolic activity, such as cancers
    • MRI scan—a test that uses magnetic waves to make picture of structures in the abdomen

Talk to your doctor about your medicines, herbs, and dietary supplements. You may be asked to stop taking some medicines up to one week before the procedure, like:

  • Aspirin and other nonsteroidal anti-inflammatory drugs (eg, ibuprofen, naproxen)
  • Blood-thinning drugs, such as warfarin (Coumadin)
  • Anti-platelet drugs, such as clopidogrel (Plavix)

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery.

Description of the Procedure

The doctor will make an incision in the right upper abdomen, under the rib cage. The doctor will remove any tumors on the liver and some of the surrounding healthy tissue. Sometimes, the gallbladder will also need to be removed. The doctor may use an ultrasound probe to examine the liver during surgery to make sure there are no remaining tumors. Your doctor may leave a drain going from inside your abdomen to outside your body. This will drain any blood or leakage from the liver. The doctor will close your incision with stitches or staples.

Immediately After Procedure

You will be taken to the intensive care unit for about 24 hours. The hospital staff will monitor you.

How Long Will It Take?

3-7 hours

How Much Will It Hurt?

Anesthesia prevents pain during surgery. Pain or soreness during recovery will be managed with pain medicine.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay is 4-8 days. If you have any problems, you will need to stay longer.

Post-procedure Care

At the Hospital

  • You will receive nutrition through an IV. It will be removed once you are eating and drinking, usually in few days.
  • You may have drains from the incision site to help the wound heal properly. Drains are usually removed before you leave the hospital.
  • You may have a small catheter put into your bladder to drain urine. It will be removed in a few days.
  • You will be given medicines to manage pain. These may be given through injections, your IV, or through a pump attached to a needle in your arm.
  • You may be given medicines to prevent nausea.

At Home

When you return home, do the following to help ensure a smooth recovery:

  • Change your bandages as directed by your doctor.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Take pain medicines as needed.
  • You may begin to feel better in about six weeks.
  • Be sure to follow your doctor’s instructions.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

  • Redness, swelling, increasing pain, excessive bleeding, warmth, drainage, or bulging at the incision site
  • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or that last for more than two days after discharge from the hospital
  • Severe abdominal pain
  • Signs of infection, including fever and chills
  • Cough, shortness of breath, or chest pain
  • Pain and/or swelling in your feet, calves, or legs
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Feeling weak or dizzy

In case of an emergency, CALL 911.

RESOURCES:

American Cancer Society
http://www.cancer.org/

American Liver Foundation
http://www.liverfoundation.org/

CANADIAN RESOURCES:

Canadian Cancer Society
http://www.cancer.ca/

Canadian Liver Foundation
http://www.liver.ca/

References:

Fernandez, FG, Drebin, JA, Linehan, DC, et al. Five-year survival after resection of hepatic metastases from colorectal cancer in patients screened by positron emission tomography with F-18 fluorodeoxyglucose (FDG-PET). Ann Surg. 2004;240:438.

Hartog A, Mills G. Anaesthesia for hepatic resection surgery. Contin Educ Anaesth Crit Care Pain. 2009;9(1):1-5.

Hepatic metastatic disease. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated September 2010. Accessed February 2, 2011.

Lai LW. Hepatic resection for colorectal liver metastases. Singapore Med J. 2007;48(7):635.

Liver cancer: treatment and drugs. Mayo Clinic website. Available at: http://www.mayoclinic.com/health/liver-cancer/DS00399/DSECTION=treatments-and-drugs. Updated July 2009. Accessed February 2, 2011.

Surgical resection. UPMC Liver Cancer Center. UPMC website. Available at: http://www.upmc.com/Services/liver-cancer-center/livercancertreatments/surgical-resection/Pages/default.aspx. Accessed February 2, 2011.

Treatment for secondary liver cancer. Macmillan Cancer Support website. Available at: http://www.macmillan.org.uk/Cancerinformation/Cancertypes/Liversecondary/Treatingsecondarylivercancer/Treatmentoverview.aspx. Updated September 2010. Accessed February 2, 2011.

van den Broek MA, Damink SM, Dejong CH, et al. Liver failure after partial hepatic resection: definition, pathophysiology, risk factors, and treatment. Liver Int. 2008;28(6):767-780.

Zakaria S, Donohue JH, Que FG, et al. Hepatic resection for colorectal metastases: value for risk scoring systems? Ann Surg. 2007;246 (2):183-191.

6/6/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.



Last reviewed March 2011 by Marcin Chwistek, MD


Last updated Updated: 6/6/2011

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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