Liver Cancer Surgery for Treatment

Liver cancer is usually the result of another long-standing liver disease, such as hepatitis B or C, alcohol or fatty liver. These conditions cause scar tissue build-up (cirrhosis) that can affect liver function.

When doctors decide how to treat liver cancer, they have to consider both the cancer and the condition of the underlying liver. If the cancer is discovered before it has begun to spread, liver cancer surgery offers patients a chance at long-term survival. There are two types of liver cancer surgery available:

• Partial hepatectomy — Part of the liver with the tumor is removed
• Liver transplant — The entire liver is replaced

A partial hepatectomy involves removing the portion of the liver that contains the tumor. While a person can survive when some organs, such as the colon or stomach, are removed, the liver is necessary for survival. Therefore, surgeons will perform the surgery only if they believe that they can:

• Safely remove the tumor, and
• Leave enough functioning liver to meet the patient's needs.

A partial hepatectomy is typically recommended for patients with good liver function (classified as Child-Pugh class A) and tumors that haven’t begun to spread. Whether partial hepatectomy is appropriate depends on:

• The size and location of the tumor(s)
• The function of the liver and
• The general condition of the patient.

The liver has a unique ability to regenerate, and up to 75% of a normal liver can be safely removed. Surgeons are careful to try and preserve as much of the functioning liver tissue as possible. With time, the remaining liver will regrow, almost reaching its original size and giving patients renewed hope for a healthy future.

Doctors may consider a liver transplant if the underlying liver disease is too severe to allow for a safe partial hepatectomy. A hepatectomy is carried out to remove the entire diseased liver, followed by a liver transplant with either:

• A whole liver from a deceased donor, or
• Part of a liver from a living donor.

A transplant lowers the chance of cancer coming back because the new liver is healthy without cirrhosis. However, patients need to take medicine after a transplant to block their immune system from rejecting the liver.

Liver transplants are appropriate for patients with early-stage liver cancer, which means:

• A single tumor <= 5 cm, or
• Two to three tumors all <= 3 cm.

A major challenge with liver transplant is finding a donor organ. The waiting list in most places is long, and not all centers are able to do transplants with living donors. During the wait for a liver, other nonsurgical treatments may be recommended to manage the disease.

Imaging with either computed tomography (CT) or magnetic resonance imaging (MRI) is of critical importance to be sure that surgery is possible and that there is no sign of cancer spread. There are no universally accepted criteria to determine whether patients with liver cancer are eligible for partial hepatectomy or transplant, but key considerations include:

• The number, size and location of the tumor(s)
• The condition of the underlying liver
• The patient’s overall health and ability to tolerate surgery and
• The patient’s personal preference and willingness to undergo surgery.

In general, patients with a single tumor and preserved liver function are candidates for partial hepatectomy, while patients with decreased liver function and early-stage cancers are candidates for transplant. However, the decision-making process is complex and needs to happen in the context of a multidisciplinary care team. In appropriate candidates, the results of both partial hepatectomy and liver transplant are excellent, with five-year survival rates around 75% and good quality of life.