Life After Partial Hepatectomy for Liver Cancer Patients

A partial hepatectomy is a treatment option for early-stage liver cancer. It can be performed through laparoscopy/robotic, or open surgery. Recovery involves a series of well-monitored steps to ensure a smooth healing process.

This article outlines what patients can expect after surgery, from hospital care to scar management and the next steps for those who are cancer-free or those who discover additional cancer.

During the first two days, patients may have tubes in place to drain fluid and provide nourishment. The care team will closely monitor vital signs and watch for complications, such as bleeding or infection.

Patients will continue to stay in the hospital for five to seven days, where they:

• Will be reintroduced to liquids and soft foods
• Undergo careful pain management – laparoscopic/robotic surgery patients usually require less pain medication; open surgery patients may experience more intense pain and need intravenous pain relief initially, which is gradually replaced by oral medications
• Have their liver function monitored through blood tests to detect any signs of complications
• Receive medication adjustment if needed
• Have their exercise tolerance assessed

Liver regeneration starts a few days after the surgery when it resumes functioning. It may take a few weeks to a few months for the liver to completely regenerate. But a more damaged liver (cirrhotic or fatty liver, or chronic liver disease) may take much longer to regenerate. Doctors monitor liver regeneration via blood tests, including:

• Complete blood count
• Comprehensive metabolic panel
• Liver function panel

After surgery, the tumor and surrounding tissue will be sent to the lab for a histological analysis. This examination under a microscope helps confirm whether all cancerous cells were successfully removed.

Additionally, follow-up imaging scans (such as CT or MRI) may be performed to evaluate the remaining liver, to ensure there are no immediate complications, and to check for any signs of cancer that may have been missed during surgery.

After a partial hepatectomy, the surgical incision will need special care to minimize pain. Most patients experience discomfort around the incision, which can be managed through a combination of medications and proper wound care.

Wound care: If you have laparoscopic/robotic surgery, you’ll have four to six small scars. In contrast, you will have a long scar that’s 6 to 12 inches if you have open surgery. Keep the surgical site clean and dry to prevent infection. Be sure to report any signs of redness, swelling, discharge, or fever to your doctor promptly.

Medications: Pain at the surgical site is common, but it can be managed with prescribed pain relievers. Laparoscopic/robotic surgery often results in milder pain. On the other hand, open surgery may need stronger pain medications during the first few days after surgery. As healing progresses, patients can transition to over-the-counter options like ibuprofen or acetaminophen.

Additionally, most patients may need medications to prevent blood clots.

Follow-up tests: Patients continue to get their routine blood tests checked to follow their liver regeneration. Additionally, the National Comprehensive Cancer Network (NCCN) Guidelines recommend the following surveillance tests for liver cancer patients after a hepatectomy,

• Imaging tests (either one of the following):
  • Computed tomography (CT) scan or
  • Magnetic resonance imaging (MRI)
• Alpha-fetoprotein (AFP) or carcinoembryonic antigen (CEA) tumor marker test, depending on the type of tumor

Recommended surveillance schedule:

• First two to three years - every four months
• Following years - every six months

Things NOT to do after hepatectomy

It's important to give your liver the care it needs by allowing yourself ample time to recover fully and properly. Here are several things you should avoid during your home recovery:

• Pushing yourself too hard - Instead, take things gradually towards recovery.
• Staying inactive - While rest is important, light exercises can gradually increase your strength and stamina.
• Engaging in strenuous activities - If you’re used to an active lifestyle, hold off on vigorous exercises until your doctor gives you the all-clear.
• Heavy lifting - Lifting heavy things may cause strain or injury. Get help for heavy tasks and prioritize your recovery.
• Returning to work or driving too soon - Take a few weeks off work to focus on healing. Consult your doctor before resuming driving or work.
• Drinking alcohol - Alcohol can harm your liver and delay recovery. Consult your doctor before drinking again.

In some cases, follow-up tests may reveal signs of cancer remaining in the liver, or that has spread to other parts of the body. For instance:

• A positive surgical margin or the presence of cancer cells is found in the tissue surrounding the tumor, indicating that not all the cancer was removed during hepatectomy
• Follow-up imaging tests detect tumors in other body parts

If cancer recurs, another surgery may be recommended. In cases where cancer recurs, and liver resection is not an option—due to the presence of insufficient healthy liver or severely compromised liver function—liver transplantation may be considered for a very selective group of patients, provided the cancer has not spread outside of the liver.

For patients with cancer that has spread, the next step may involve chemotherapy, immunotherapy, targeted therapy or a combination of these therapies. For these patients, recovery can be more challenging, and they may need further treatments to help manage the cancer.

For those with no signs of cancer after surgery, the next step is cancer survivorship and long-term health maintenance. While the liver will regenerate naturally, patients should follow a structured plan to support their healing and prevent future liver problems.

Patients will undergo regular cancer surveillance tests to monitor for any signs of recurrence. With careful management and lifestyle adjustments, most NED patients can expect to lead full, active lives. For those with cirrhosis or other underlying liver conditions, ongoing liver-related care remains important. This may include treatments like antiviral therapy for active hepatitis B or C infection.

Related: Life After Cancer: Liver Cancer

Recovering from a partial hepatectomy involves careful hospital monitoring, wound care and pain management, followed by ongoing evaluations to track liver health and cancer status. For patients clear of cancer, the focus is on restoring normal life, while for others, further treatment may be necessary. Regardless of the situation, working closely with a healthcare team will help guide patients through recovery and ensure they receive the care they need.