Liver Cancer Surgery
- Surgery is often the initial treatment considered for liver cancer, especially if disease is early stage and the tumors are confined.
- Eligibility for surgery depends on various factors, including tumor spread, size and location, plus your overall health and liver function.
- The two primary surgical approaches for liver cancer are open surgery, which involves a larger incision (cuts), and minimally invasive surgery, which involves smaller incisions and specialized instruments.
- Under the right circumstances, surgery can actually provide a cure, though it also comes with risks such as bleeding, infection, and extended recovery time.
“Primarily we would like to remove the liver tumor if possible,” Dr. Elliot Newman, the chief of surgical oncology at the Northwell Health Cancer Institute at Lenox Hill Hospital in Manhattan, tells SurvivorNet.
Read MoreAm I a good candidate for surgery?
In most cases, doctors will strongly consider surgery for liver cancer, particularly when the tumor is confined to the liver and hasn’t spread.If the circumstances are right, surgery offers a chance for a cure.
“When it comes to assessing patients for suitability for surgery with respect to liver cancer, we look at a number of different things,” Dr. Newman explains.
“Assuming that the patient is a surgical candidate (health enough to tolerate the surgery), then we have to look specifically at the nature of the liver tumor that we’re dealing with and whether it can be safely removed,” he adds.
Your doctor will consider surgery if:
- The disease is early stage
- The tumor is small, typically less than 5 cm
- There are a few, isolated tumors
- Tumors are located in places that are easily reachable
- You are in good general health with adequate liver function
- You don’t have significant cirrhosis (liver scarring) or other liver diseases
Keep in mind that not everyone diagnosed with liver cancer is a good candidate for surgery. It’s an option that’s right for about a third of liver cancer cases.
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If you are one of the 30,000 or so people diagnosed with liver cancer every year, surgery may be an option. Doctors may recommend surgery either on its own or in combination with some other therapies such as chemotherapy or drugs that specifically target the cancer while avoiding the healthy tissue.
Dr. Newman says that for many patients, surgery leads to excellent results.
“That is by far the best way to give us the best chance of achieving a cure,” he points out.
What types of surgery are there for liver cancer?
There are two types of surgery your care team will consider for treating liver cancer: open and minimally invasive.
Open surgery
Traditional open surgery involves making a large incision (cut into the body) so your doctor can directly access and treat the affected area.
Open surgery offers clear visibility and space for the surgeon to operate.
Though it has risks, including a longer recovery period, it’s considered a good option for complex or large-scale procedures. However, it does carry the potential for a longer, more painful recovery period.
There are two methods of open surgery:
- Traditional Liver Resection: This is used for more complex cases. The surgeon makes a large incision to remove the tumor, leaving part of the liver in place.
- Liver Transplantation: When the liver is very damaged by cancer and other treatments won’t work, your doctor may recommend a full liver transplant which replaces the diseased liver with a healthy one from a donor.
Minimally invasive surgery
Minimally invasive surgery uses small incisions and specialized instruments, such as a laparoscope, to remove cancerous tissue with less stress on the body compared to traditional open surgery.
“We certainly see benefits in minimally invasive surgery when it’s possible because patients have smaller incisions and can recover more quickly and get out of the hospital more quickly and get back to full functionality more quickly,” explains Dr. Newman.
Considerations for either open and minimally invasive surgeries Include:
- Tumor size
- Tumor location
- Number of tumors
- Your overall health and liver function
Types of minimally invasive surgery and procedures:
- Laparoscopic Liver Resection (LLR): Removal of liver tumors through small incisions using special tools
- Robotic Liver Resection (RLR): Similar to LLR, but uses a robotic system for enhanced precision
- NanoKnife Ablation: Utilizes electrical currents to target and destroy small tumors
- Cryoablation: Employs extreme cold to freeze and kill cancer cells
- Microwave Ablation: Uses microwave energy to heat and destroy cancer cells
- Irreversible Electroporation (IRE): Destroys cancer cells with electrical pulses, sparing surrounding tissue
Related: Bile Duct Cancer and Liver Cancer — Same Organ But Different Diseases
What are the risks and benefits of surgery?
If your doctor believes that surgery is the right treatment option for you, it could lead to some big benefits.
These include a possibility for a cure (especially if you have early-stage disease), quick relief of symptoms (due to immediate removal of the tumor), and a reduction in pain and recovery time thanks to advanced surgery techniques.
Of course, every medical procedure comes with some risks — and surgery is no different.
Risks include:
- Bleeding, infection, and complications related to anesthesia
- Recovery time, even with minimally invasive techniques
- The need for additional treatment if surgery does not remove all of the cancer
Will I need additional treatment?
Some patients might also need other types of treatment before or after surgery to help get their cancer under control.
The decision to undergo treatment beyond surgery depends on the stage of cancer, whether or not any cancer remains after surgery, and your overall health.
Common additional treatments include:
- Chemotherapy to prevent recurrence
- Radiation Therapy to kill the remaining cancer
- Targeted drugs that hit specific cancer mechanisms or genetic markers while preserving healthy cells
- Immunotherapy to boost the body’s immune system
- Ablation Therapies with techniques like radiofrequency ablation or microwave ablation to “kill off” small tumors that remain or recur
According to Dr. Newman, the need for added treatment depends on a detailed assessment by your care team.
“.. it’s very important to realize that we have made a lot of progress in the last couple of decades both in the terms of the surgical approaches that we can do now more minimally invasively which allows you to recover faster,” he says.
He adds: “And in terms of the medications and drugs that we can use to treat afterwards in the form of chemotherapy or very newer drugs that are called targeted agents…”
Questions to ask your doctor
- Am I a good candidate for surgery?
- What types of surgery will you consider?
- What results can I expect?
- What side effects can I expect and how will we manage them?
- What part of my treatment is covered by insurance and how much can I expect to pay out of pocket?
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