Liver Resection

The liver is divided into eight segments, each with its own blood supply and bile drainage, which allows surgeons to remove one or several segments while preserving the rest. A minor resection removes a wedge or one or two segments; a major resection, such as a right or left hepatectomy, removes three or more segments, and an extended resection removes even more. The key limit is the future liver remnant: the part left behind must be large and healthy enough to keep the body working while it regrows. In a normal liver, around a fifth to a quarter of the original volume can be enough; in a liver affected by cirrhosis or extensive chemotherapy, more must remain. After surgery the remaining liver cells divide and the organ regains most of its volume within about six to eight weeks, although its shape changes. Liver resection is planned jointly by surgeons, oncologists, radiologists and liver specialists.

Liver resection is recommended when a tumour or other disease is confined to a part of the liver that can be removed completely while leaving enough healthy liver behind. The commonest reason is metastases from bowel cancer, where removing all liver deposits, often combined with chemotherapy, offers a real chance of long-term control or cure. It is also a main treatment for hepatocellular carcinoma in people with good liver function, usually alongside an assessment of whether transplantation or ablation would suit them better, and for cholangiocarcinoma arising within the liver. Selected metastases from other cancers, such as neuroendocrine tumours, may also be removed. Benign indications include large or symptomatic adenomas, some cysts and lesions in which cancer cannot be excluded. When cirrhosis is advanced or the tumours are too widespread, liver transplantation, ablation, radioembolisation or systemic treatment may be advised instead, as decided by a multidisciplinary tumour board.

Liver resection is done under general anaesthesia, often with an epidural or other regional pain relief. Smaller resections in accessible segments are increasingly done laparoscopically or robotically through several small cuts, while major or complex resections are usually done through an open incision under the ribs. The surgeon first examines the whole liver, often with an ultrasound probe placed on the liver surface, to confirm the position of the tumours and their relation to the blood vessels. The vessels and bile ducts supplying the part to be removed are controlled and divided, and the liver tissue is cut with specialised instruments that seal small vessels and bile ducts as they go. The anaesthetist keeps the pressure in the veins low to reduce bleeding. The cut surface is checked for bleeding and bile leak, and a drain may be left. The operation usually takes about 3 to 6 hours.

Candidacy rests on three points: whether all the disease can be removed, whether enough healthy liver will remain, and whether you are fit for major surgery. Imaging with contrast CT and liver-specific MRI, and often a PET scan, maps the tumours. Blood tests and sometimes specialised scans assess liver function, especially in cirrhosis, and CT volumetry calculates the size of the future remnant. If it is too small, portal vein embolisation or a two-stage operation can make the remaining liver grow before the main resection. Chemotherapy is often given before surgery for bowel cancer metastases, and its effect on the liver is taken into account. Heart and lung fitness, nutrition, alcohol use and diabetes are reviewed, and stopping smoking helps recovery. International patients can send their scans and reports for a multidisciplinary review, which shows whether resection is possible and how long the stay is likely to be.

After a major resection you may spend a day or two in intensive or high-dependency care while liver function, blood tests and fluid balance are monitored. Walking, breathing exercises and eating start early under enhanced recovery principles. Pain is controlled with an epidural, nerve blocks or medicines given through a drip, then with tablets. The hospital stay is usually about 4 to 10 days, shorter after keyhole surgery. Fatigue is the main symptom for several weeks while the liver regrows, and most people return to normal activity within about six to eight weeks. Heavy lifting waits until the wound has healed. For travel, plan about two to three weeks abroad after surgery so the team can confirm recovery, review the pathology and discuss further treatment. Chemotherapy or surveillance scans can usually continue at home, guided by the full surgical and pathology reports.

Liver resection is major surgery, with risks that depend on the extent of the resection and the health of the liver. Bleeding during or after surgery is the classic risk, reduced by careful technique and anaesthesia. A bile leak from the cut surface occurs in some patients and is usually treated with a drain or an endoscopic stent. Fluid collections, wound and chest infections and blood clots can also occur. The most serious risk after a major resection is post-hepatectomy liver failure, in which the remaining liver cannot keep up; it is uncommon with careful planning but more likely in cirrhosis or after extensive chemotherapy. Long-term results depend on the disease: many people with bowel cancer metastases live for years after resection and some are cured, while recurrence in the liver is common and can sometimes be treated with further surgery or ablation. Regular follow-up scans are part of care.