The liver is an amazing organ and has the ability to re-grow, even if a large part of it is removed. The surgery (known as liver resection) is usually done in specialist hospitals where the hepato-biliary teams have a lot of experience and skill at performing these operations, and in caring for patients after the operation.
This might mean that it is not available in your local area, and you have to travel some distance to have the surgery. If this is the case, then it may also affect how you feel about having the operation. It may help to discuss this fully with your family and maybe with other patients that have been through a similar experience. This is something that can be arranged through the Bowel Cancer Voices network by contacting our nurse helpline.
For some people, the operation is straightforward and can be done immediately. Other people may need to have some chemotherapy or other treatments first, to try and shrink the tumours, making them easier to remove.
Alternatively, it may be that you need to have another procedure, called portal vein embolisation, done first, to encourage a new healthy segment of liver to grow before you have the main surgery; this avoids the risk of having to take away too much of the liver in one operation.
In some cases, it may be possible to have surgery which will remove both sides of a diseased liver, one lobe at a time. This can be done in two separate operations scheduled several weeks apart, provided you are well enough to have the surgery and that there are no other signs of active disease in your body.
Surgery is scheduled in this way because your doctors want to be sure that there is a good chance of a successful outcome in terms of your quality of life after the surgery, and your long-term survival. It is also possible to have repeat surgery if your liver metastases recur. This and other treatment options will be discussed at the MDT meeting.
Liver resections are usually performed during ‘open’ surgery through an incision in your abdomen, and can take between three and seven hours. It may sometimes be possible to remove liver metastases by keyhole (laparoscopic) surgery, although this may not be an option if the size and/or number of tumours would make the operation too complex to be carried out safely in this way. There may also be times when laparoscopic surgery is started, but the surgeons find that they need to convert to open surgery to ensure they remove all the visible cancer cells.
This is a major operation and you will normally be admitted to a high dependency unit or liver intensive therapy unit for a day or so following surgery. This allows you to be monitored closely immediately after the operation. You would normally expect to stay in hospital for five to seven days following liver surgery.
In some cases you may be advised to have further chemotherapy after liver surgery.