Liver Resection
There are numerous types of liver resections that can be performed for liver cancer; the more commonly performed type of operations are right and left hepatectomy, extended right hepatectomy (also called trisegmentectomy), and left lateral segmentectomy.
The type of operation you receive depends primarily upon the size of your tumor, how many tumors are present and their location in the liver. Your surgeon should take out as much liver as necessary in order to get all of the cancer out.
If you are a candidate to undergo a liver resection, then you should be referred to a surgeon who is competent in performing liver surgery. Issues that you should consider addressing with your surgeon are listed below:
- Will liver resection make a difference in my outcome?
- Should I receive chemotherapy before or after the operation?
- If you find more than one tumor that you cannot remove, what will you do in the operating room? Will you just close me up?
- Will you consider using radiofrequency ablation or cryotherapy and if so, will either procedure help?
- Will placing a hepatic artery infusion pump alone or after liver resection be of any use?
- Are you experienced in these techniques and do you have them at your disposal should you wish to employ them?
- Am I a candidate to participate in a clinical trial which is designed to help answer the above questions, particularly if my tumors are found not to be removable?
- Is there a role for liver transplantation?
If your surgeon cannot answer the above questions or does not have experience in these techniques or if the various techniques discussed above are not available in their hospital you should ask your surgeon to refer you to another liver surgeon or hospital that has access to these methods of treatment. Furthermore, if you desire to participate in a research study which explores new ways of treating tumors in the liver, you should ask your surgeon if any such trials are any being offered by any groups such as The American Cancer Society, the National Cancer Institute, or American College of Surgeons in their hospital or any other hospital in which you could be treated. Vanderbilt has a world renowned hepatobiliary surgery service at the VICC.
Patients with cancer of the liver are treated by a variety of different specialists today: oncologists, radiation oncologists, hepatobiliary liver transplant surgeons, radiologists, and gene therapists. These physicians employ a variety of different approaches and therapies to treat patients. Sometimes you may be treated well by a single physician depending upon the status of your disease. Other times, it is best that you be treated by a variety of different methods (for example, chemotherapy and surgery) and by more than one specialist. This type of therapy is referred to as multidisciplinary. The treatment of patients with cancers confined to the liver (primary or metastatic) has dramatically improved and become much safer over the past ten to fifteen years when patients are treated by a multidisciplinary team of physicians and surgeons in a hospital that specializes in liver tumors. The risk of dying during or after a liver operation when it is performed by an experienced surgeon should be less than 1 in 100. Alternatively, the risk of dying from a liver operation when operated upon by a surgeon without proper training or in a hospital where liver operations are not commonly performed increases substantially.
Patients and/or their families have a right to know the experience and results of their doctors and should feel comfortable asking their surgeon and oncologist about their personal experience and results. If your physician is defensive and/or not willing to share with you his/her results then you may want to consider an alternative evaluation. The following set of questions are very reasonable to ask your surgeon prior to deciding on if you want them to care for you:
- How many of these operations have you done in your life and in the past year?
- What is your complication and death rate?
- How long do you expect my operation to last?
- Who will be helping you do this operation?
- Can I donate my own blood?
- How long do you think I will have to stay in the hospital?
How do you select a surgeon or other physician based upon the answers to the questions above?
First and foremost, you want to select a surgeon who compassionately tells you about the natural history of your disease and truthfully discusses with you the chances of your being cured or living longer. Secondly, it is important to have a physician who cares as much about preserving your quality of life as the duration of your life since this is a disease that is very difficult to cure. Thirdly, you want a surgeon who has a lot of experience, works as part of a team with other competent doctors and whose mortality rate after liver operation is less than 3%. Your surgeon should also be able to perform a major liver resection with very little risk of giving you a blood transfusion. These are specific consideration for resection in primary liver tumors and metastatic tumors to the liver. These are covered in more details in those specific sections.
