The liver is a large organ that lies under the ribs on the right side of the abdomen. It is a complex organ that fulfils a wide range of functions. It is involved in the regulation of carbohydrate, protein and fat metabolism. It also makes bile that is an important digestive juice. The liver plays a role in the immune system.
Uniquely, the liver has the ability to regenerate if it is damaged or part of it is removed. This allows us as surgeons to remove up to 75% of a healthy liver, which gives significant scope for removing tumours that develop in the liver.
In Southampton we have led the development of keyhole liver surgery in the UK. Approximately half of liver resections that we perform are done using keyhole (laparoscopic) surgery. This has the advantage of a shorter hospital stay and a more rapid return to normal activities.
Liver resection is often part of a series of treatments directed at liver tumours. Because many specialists are involved your case will be discussed by a team of experts (multidisciplinary team) prior to starting treatment.
Liver resection is a major operation and if you require this surgery, I would discuss the procedure, recovery times and potential post-operative problems in detail during pre-operative consultation.
Tumours in the liver can be primary (i.e. grow from the liver) or secondary tumours that have originated elsewhere (e.g. bowel cancer). The tumours that we regularly encounter are summarized below.
1. Hepatocellular Carcinoma (HCC).
These tumours normally develop in cirrhotic livers. Liver cirrhosis is characterised by scarring of the liver due to chronic damage from alcohol, hepatitis viruses and certain autoimmune diseases (conditions where the immune system attacks the liver). They can be suitable for surgery but more often we treat them with TACE. TACE (trans-arterial chemoembolisation) is a procedure that sets to deliver chemotherapy in high doses directly into the tumour, whilst simultaneously blocking the blood supply to the tumour. This is effective but does not remove the tumour.
These tumours can develop anywhere in the bile ducts, both within the liver and in the bile ducts running from the liver to the bowel. Those in or near the liver usually require some of the liver to be removed if surgery is a planned part of the treatment. Cholangiocarcinomas are discussed in detail in the bile duct and gallbladder section.
1. Colorectal Liver Metastasis
Most liver resections are performed to remove colorectal liver metastasis. The management of bowel cancer has developed very rapidly in the last two decades. In the past, if liver metastases developed after treatment for bowel cancer, the outlook was bleak. Now with improvements in our understanding of disease, advances in surgery and chemotherapy, there is real hope. Currently, liver surgery usually takes place between courses of chemotherapy. Once again the management and timing of treatment is discussed with your oncologist and tailored specifically to an individuals needs.
2. Neuroendocrine (NET) or Carcinoid Liver Metastasis
Liver metastases are a common problem in neuroendocrine disease. In the past there has been reluctance to perform liver surgery unless it was possible to remove all the disease. However, in Southampton we firmly believe that there is a roll for liver resection as part of a multi-modality targeted approach to the disease. We have all the expertise within the team to make a difference and take a very proactive approach.
Please follow this link: www.planets-carcinoid.org
There is also plenty of information at: www.enets.org/uk
3. Other Liver Metastasis
We are increasingly prepared to perform liver surgery for a variety of other secondary tumours including:
- Ovarian cancer
- Malignant melanoma
- Small bowel cancer
- Breast cancer
Each particular case needs to be assessed on its own merits and discussed in the context of other factors that may impact on the disease
Liver cysts are extremely common and the vast majority cause no symptoms and are entirely harmless. Sometimes we operate to remove liver cysts if they are very large and are pressing on other internal organs.
There is a rare form of cyst called a biliary cystadenoma, which has the potential to become cancerous if left unchecked. It is usually possible to identify these on scans, however, if there is any doubt, we would normally recommend that they are removed.