Hepatectomy is a surgical procedure performed to remove a diseased liver. The liver is one of the most vital organs present in the body. The liver is basically divided into sections, called lobes, and acts as a filter for blood. Hence, a segment can be safely removed without affecting other parts of the liver. It eliminates harmful substances from the blood that is later passed out of the body as waste. It performs several vital functions such as:
- Digestion through secretion of bile
- Digests and stores other nutrients from foods like sugar
- Removal of toxins
- Production of clotting factors
Frequently Asked Questions
What is a hepatectomy?
A hepatectomy is a surgical procedure that involves the partial or complete removal of the liver.
Why is a hepatectomy performed?
Hepatectomy is performed to treat liver tumours, such as hepatocellular carcinoma or metastatic liver cancer, and other liver conditions, including liver cysts or benign tumours.
What are the different types of hepatectomy?
The types of hepatectomy vary depending on the extent of liver removal. They include wedge resection, segmentectomy, lobectomy, and extended hepatectomy.
How is a hepatectomy performed?
A hepatectomy is typically performed under general anaesthesia. The surgeon makes an incision in the abdomen, removes the diseased portion of the liver, and takes measures to control bleeding and ensure proper bile flow.
Is a hepatectomy a major surgery?
Yes, a hepatectomy is considered a major surgical procedure because of the complexity of the liver and the potential risks involved.
What are the risks and complications associated with hepatectomy?
Risks and complications of hepatectomy may include bleeding, infection, bile leakage, liver failure, blood clots, and damage to surrounding structures.
How long does it take to recover from a hepatectomy?
Recovery may take several weeks to a few months. The extent of liver resection, individual healing, and overall health factors contribute to the recovery duration.
Will there be pain after a hepatectomy?
Pain is expected after a hepatectomy. Pain medications are usually prescribed to manage discomfort during the recovery period.
Can a hepatectomy affect liver function?
Yes, a hepatectomy can impact liver function, especially if a significant portion of the liver is removed. However, the liver has the ability to regenerate, and the remaining liver tissue can compensate for the lost function.
Can a hepatectomy be performed laparoscopically?
Yes, in certain cases, a hepatectomy can be performed using minimally invasive techniques, like laparoscopy. This approach may offer advantages such as smaller incisions, reduced post-operative pain, and faster recovery.
Can a hepatectomy be combined with other procedures?
Yes, a hepatectomy can be combined with other procedures, such as liver transplantation, bile duct reconstruction, or removal of adjacent tumours, if necessary. The decision depends on the individual case and the surgeon's judgment.
Can a hepatectomy be performed in patients with cirrhosis?
Hepatectomy can be performed in patients with liver cirrhosis if they meet specific criteria and if the surgery is deemed necessary and beneficial. The decision is based on evaluating the patient's liver function and overall health.
How does liver regeneration occur after a hepatectomy?
The liver has a remarkable ability to regenerate. After a hepatectomy, the remaining healthy liver tissue begins to grow and multiply, gradually restoring the liver's size and function.
Can a hepatectomy cure liver cancer?
A hepatectomy can be curative for certain types and stages of liver cancer, especially when the tumour is confined to the liver and can be completely removed. However, long-term follow-up and monitoring are still necessary.
Can a hepatectomy be performed in patients with metastatic liver cancer?
Hepatectomy may be considered for patients with metastatic liver cancer if the tumours are limited in number, size, and location and if the primary cancer site is under control. The decision is made based on a thorough evaluation of the patient's overall condition.
Can a hepatectomy lead to liver failure?
While hepatectomy carries a risk of liver failure, it is relatively low. Surgeons take precautions to preserve adequate liver function and ensure sufficient healthy liver tissue remains after the procedure.
Can dietary changes help after a hepatectomy?
Following a hepatectomy, a healthy and balanced diet is essential for optimal recovery. Your healthcare team may provide specific dietary guidelines based on your individual needs.
Can a hepatectomy affect digestion and nutrient absorption?
Hepatectomy may have some impact on digestion and nutrient absorption, particularly if a significant portion of the liver is removed. However, the remaining liver tissue can often compensate, and any potential issues can be managed through dietary adjustments and, if necessary, supplemental measures.
Can a hepatectomy be performed using robotic-assisted techniques?
Yes, in certain cases, a hepatectomy can be performed using robotic-assisted techniques. Robotic surgery offers enhanced precision, dexterity, and visualization for complex liver procedures.
Can a hepatectomy be performed on pediatric patients?
Yes, hepatectomy can be performed on pediatric patients when necessary, such as for liver tumours or congenital liver abnormalities. Specialized pediatric surgical teams are involved in the care of pediatric patients undergoing hepatectomy.
Reviewed by Dr. Nikhil Agrawal, Director - Cancer Care / Oncology, Surgical Oncology, Gastrointestinal & Hepatobiliary Oncology, Gastro Intestinal & Hepatopancreatobiliary Surgical Oncology, Robotic Surgery.
Conditions Treated with Hepatectomy Surgery
Hepatectomy surgery is performed for several conditions which affect the liver. These are as follows:
Hepatocellular carcinoma. It consists of cancers arising from liver cells and are limited to one part of the liver. These can easily be treated with Partial Hepatectomy, whereas cancers that spread to the liver from the colon or carcinoid tumour, a part of the liver can be resected if the cancer is restricted to one part of the liver.
Benign liver tumours
Parasitic cysts in the liver
Large liver hemangiomas
Chronic or acute liver failure
Diagnosis Before Hepatectomy Surgery
Apart from general blood tests like CBC and kidney function tests, certain other liver-specific tests are advised as well. These are as follows:
Higher AFB levels in people with liver tumours indicate malignancy. The protein is used as a marker for liver cancers and certain other tumours. It also serves as a marker for patients on follow up basis, and if the level rises again, it indicates the return of the disease.
Liver Function Tests:
These are recommended to be done before the surgery in order to check the status of liver functioning.
Blood clotting tests:
The liver helps prevent bleeding by the production of some proteins that help in clotting. A compromised or damaged liver is unable to make enough of these clotting factors, which could increase the risk of clotting. Prothrombin time and partial prothrombin time(PTT) are the two tests that come under this category.
This is done initially to know about the extent of the disease and the damage involved. Based on the ultrasound findings, other imaging tests are advised as well, or even a biopsy is performed to confirm the diagnosis.
This helps to differentiate between benign and malignant tumours. After a plain MRI, a contrast dye called Gadolinium is inserted into the vein to assess the blood vessels and other associated structures more clearly. It also gives details about other parts of the body.
Positron Emission Tomography (PET):
This nuclear medicine imaging technique provides a three-dimensional image of the liver or pancreas and other surrounding structures. This is used in conjunction with a CT scan to produce more detailed and clear images of the liver.
This is done to assess the structures of various blood vessels of an organ. These give information regarding the extent of the tumour and help the doctors to plan the surgery accordingly. A CT or MR angiography procedure can also be performed instead of injecting into the liver artery directly. Direct injection into the liver artery is useful to guide some types of non-surgical treatment like embolization of cancer.
This consists of:
- Bone scan: This is recommended only in cases where the doctors suspect that cancer has spread to the bones.
- Radio-labelled meta-iodobenzyl guanidine (MIBG): This helps in visualizing cancers like carcinoid tumours and liver neuroblastoma.
Hepatectomy Surgery Procedure Types
Hepatectomy is performed in two ways, either through open surgery or through laparoscopy. Open surgery is the most common approach used by doctors in most cases.
In this procedure, the incision is made under the ribs and in the middle of the abdomen. Afterwards, ligaments, veins, arteries and bile ducts to the part of the liver going to be resected are identified and accordingly isolated.
Several techniques are used to remove the affected parts of the liver. These involve an Ultrasonic surgical aspirator. The laser may also be used in combination with this procedure. A wedge resection may be used for superficial lesions where only the affected part of the liver along with some other parts of surrounding tissues is removed. In certain cases, one or more affected segments or a lobe of the liver may be removed.
Surgery is performed with the help of a laparoscope. Sometimes the doctor performing this surgery may have to convert it to open surgery in case of any complication.
This procedure involves removing only one part of the liver, approximately 60% of the liver is removed, and care must be taken during surgery to minimize blood loss or any other injury to vital structures like bile ducts and blood vessels. Since the liver is very much capable of regeneration, therefore a part of the liver is removed, after which the cells of the remaining part multiply in order to replace the removed portion. This can be carried out only if the remaining part is normal.
This is also called Complete Hepatectomy and involves the removal of the entire lobe of the liver. This is followed by Liver transplantation.
Complications of Hepatectomy Surgery
These comprise of the following:
- Excessive bleeding
- Trauma to surrounding organs
- Ascites, accumulation of fluid in the stomach
- Pleural effusion
- Leakage of bile into the abdomen
- Liver failure
- Kidney failure
- Pulmonary embolism
- Post-operative pain
- Rarely death
Outlook of Hepatectomy Surgery
Liver cancer gets treated for those people who are able to receive a successful organ transplant. The liver cancer issue is also resolved for those individuals who undergo surgery to remove tumours or parts of the liver. Liver cancer, if not treated successfully, proves fatal, but researchers are working daily to find more effective treatments.
Reviewed by Dr. Karamjot Singh Bedi, Consultant, Liver Transplant and Biliary Sciences, Gastrointestinal Surgery, Surgical Gastroenterology on 02-September-2022
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