Liver lobe resection

Indications for liver resection

Indications for surgical treatment are:

• large liver hemangiomas and nodular fibrous hyperplasia located on the periphery of the organ, which cause deformation of the anterior abdominal wall and worsen the quality of life;

• primary liver cancer (hepatocellular carcinoma, cholangiocellular carcinoma);

• liver adenoma;

• secondary cancer (single and/or multiple liver metastases);

• cysts (cystadenomas and cystadenocarcinomas, cysts of the bile ducts of various localization);

• echinococcosis and alveococcosis (a parasitic disease in the cystic or multilocular variant);

• traumatic injury (liver and bile ducts)

• rare non-epithelial liver tumors (hemangioendotheliomas, sarcomas, lipomas, hamartomas, pseudoinflammatory tumors)

Also, intervention on the liver can be prescribed in the case of more rare pathologies of abscesses, stones in the biliary tract, Karoli's disease.

Contraindications

When surgery is considered as a method of treatment for cancer, the possibilities of its implementation are evaluated according to the Child-Pugh criteria. In this case, indicators of the general condition of the body are used (albumin level, blood clotting, the presence of fluid in the abdominal cavity, the presence of encephalopathy). The operation is performed only if preliminary studies show that all indicators are within the normal range or have changed slightly. With decompensated cirrhosis of the liver, when liver resection is impossible due to low functional reserves or due to severe concomitant diseases or the patient's refusal of liver resection, it is possible to use minimally invasive local treatment methods such as cryoablation, stereotactic radiosurgery, chemoembolization. In some cases, patients are referred for liver transplantation.

Surgical intervention is also contraindicated in the following cases:

• significant liver damage (more than 80%);

• the presence of metastases in distant organs (spine, brain, kidneys, heart);

• cirrhosis of the liver;

• the general serious condition of the patient, in which recovery after major surgery is unlikely.;

• the tumor has affected the portal vein (it is impossible to perform surgery without the risk of extensive bleeding).

In these cases, alternative cytoreductive minimally invasive treatment methods (thermal ablation, radiosurgery, a combination of cryoablation and radiosurgery) can be used

Prognosis

The prognosis in terms of quality and life expectancy of the patient after surgery depends on the nature of the disease and the stage. A combined multidisciplinary, personalized approach to treatment allows for excellent short- and long-term results, as well as quality of life.

Frequently asked questions

How long does the liver heal after resection?

The liver regenerates well, and depending on the volume of resection, it can recover by 75% within 6 to 8 weeks, and it can take up to a month to return to normal life.

What part of the liver can be removed?

Depending on the type and volume of organ damage, the entire right or left lobe or one of the liver segments can be removed. It is believed that complete restoration of liver function is possible with the removal of up to 75%-80% of its volume. With low functional reserves of the liver (chronic hepatitis, cirrhosis of the liver, non-alcoholic metabolic liver disease), the volume of the removed parenchyma (liver tissue) in some cases should not exceed 15-25% of the total volume of the liver.

Where is the incision made during liver surgery?

If the operation is performed laparotomically, the abdominal wall incision has a J shape, then there is a median incision extended under the right hypochondrium. After healing, the scar will be almost invisible. With laparoscopic access, punctures for trocar insertion are located in several areas of the anterior abdominal wall.

Which doctor performs liver surgery?

Liver surgery is performed by a hepatopancreatobiliary surgeon.