Hepatectomy, a Surgical Procedure for Liver Cancer Treatment

There are various methods to treat liver cancer. One of the treatment methods that are often recommended by doctors is hepatectomy. Hepatectomy, either partial or total, has become an effective method for liver cancer treatment. Hence, how is the hepatectomy procedure performed? Let's explore the following article for more information about hepatectomy.

 

What Is Hepatectomy?

 

According to data from the Global Cancer Observatory (Globocan) 2022, liver cancer is the second leading cause of death after lung cancer in Indonesia. To prevent liver cancer from progressing to advanced stages, liver resection surgery or hepatectomy is recommended for liver cancer treatment.

 

Liver resection surgery, also known as liver cancer surgery or hepatectomy, is an invasive procedure that partially or completely removes the liver to excise the tumor and surrounding liver tissue. More details are as follows.

 

1. Partial Hepatectomy

 

Partial hepatectomy is a procedure that removes only a portion of the liver organ. The extent of removal is determined by the location and size of the tumor in the liver. When the tumor is removed, the healthy liver tissue takes over the function of the removed liver portion.

 

Partial hepatectomy is typically performed to remove liver tumors, such as hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma, or liver tumors originating from the metastasis (spread) of colorectal cancer. Additionally, partial hepatectomy can also be conducted to remove benign tumors, such as adenomas or liver cysts.

 

After total resection, the remaining healthy liver organ can regrow to its original size proportional to the patient's body over time. This recovery process depends on the ability of healthy liver tissue to regenerate. In some cases, the liver may regenerate more slowly to reach its original size.

 

2. Total Hepatectomy

 

Total hepatectomy is a surgical procedure that removes the entire liver. This procedure is usually performed in conjunction with liver transplantation. Total hepatectomy with liver transplantation is typically done in advanced liver disease or when cancer cells have spread, in which the entire liver organ needs to be removed and transplanted.

 

Eligibility Criteria for Patients Undergoing Hepatectomy

 

Hepatectomy is generally reserved for individuals with liver cancer who meet the following criteria:

 

• Patients must have good liver function or have liver cirrhosis.

• Patients are healthy enough to undergo or tolerate surgery.

• The location and extent of the tumor must be well-localized.

• There should be no widespread cancer metastasis.

• There should be no heart disease, lung disease, or other systemic diseases that may affect postoperative recovery.

 

Before performing a partial hepatectomy, doctors will ensure that the liver's vascularization and the minimum volume of the remaining liver are considered safe for regeneration and maintaining liver function after surgery. Meanwhile, patients intending to undergo total hepatectomy must fulfill all requirements for liver transplantation.

 

Procedure of Hepatectomy 

 

The hepatectomy procedure can be divided into the preparation, surgery, and postoperative recovery.

 

1. Preparation for Hepatectomy

 

Here are some general steps taken in preparation for hepatectomy:

 

• Comprehensive medical evaluation, including supporting examinations.

• Monitoring of liver function, such as SGOT, SGPT, and bilirubin.

• Checking INR and albumin levels.

• Blood coagulation profile tests, such as PT and APTT.

• Fasting and discontinuing certain medications or supplements.

 

2. Surgical Procedure

 

Partial and total hepatectomy differ in the extent of liver tissue removal performed. The following are more information about both procedures:

 

• Anesthesia. The doctor administers general anesthesia to the patient, eliminating pain during the surgery.
• Incision-making. The doctor makes an incision on the abdominal area to access the liver. The subcostal incision is made under the right rib or in the center of the abdomen.
• Liver tissue removal. In partial hepatectomy, the part of the liver affected by diseases such as tumors is identified and removed by a digestive surgeon using a scalpel or electrocauterization. Meanwhile, in total hepatectomy, the entire diseased or damaged liver is removed to be replaced with a donor liver (transplantation).
• Transplantation. In total hepatectomy, after the entire diseased liver is removed, a healthy donor heart is placed and connected with the patient's blood vessels and bile duct.
• Bleeding control. During and after the procedure, the doctor controls bleeding using the hemostatic technique, which involves the use of stitches, clamps, or other hemostatic instruments.
• Finishing. After the removal is completed, the surgeon closes the incision using stitches or dermal adhesive. Then, the patient is moved to the recovery room or intensive care unit (ICU) for further monitoring following the surgery.

 

3. After Hepatectomy

 

Liver resection recovery typically takes 6-8 weeks, and the recovery time can vary between patients. Patients are advised not to lift heavy objects or engage in strenuous exercise for 12 weeks after surgery.

 

Consuming foods that maintain liver health and adopting a healthy lifestyle every day can help accelerate postoperative recovery. Patients are also required to undergo regular checkups and diagnostic tests to monitor disease progression and recovery.

 

Risks and Complications of Hepatectomy

 

Hepatectomy is a complex procedure for treating liver cancer that carries several risks of complications. Some potential complications include:

 

• Hemorrhage.

• Infection.

• Liver function impairment.

• Liver failure.

• Pulmonary complications.

• Anesthesia-related complications.

• Organ damage.

 

That is the information about hepatectomy that you should know. It is important to note that hepatectomy is only recommended for patients after a confirmed diagnosis. Doctors will first discuss and consider the patient’s condition along with the entire medical team to ensure that the patient has met the requirements for this procedure.

 

For your information, the examination and treatment steps related to hepatectomy may vary depending on the healthcare facility at each hospital. Since not all hospitals may provide this service, medical professionals will determine the appropriate examination and treatment steps according to each patient’s medical condition.

 

Therefore, if symptoms related to liver function arise, it is best to consult your condition with a Digestive Surgeon at the nearest Siloam Hospitals for accurate evaluation, diagnosis, and treatment advice based on your condition.

You can also use the MySiloam app to browse doctors’ schedules, book an appointment with the relevant doctor, or monitor health examination results online. Download MySiloam now to enjoy various features that can facilitate your healthcare journey.