Open Liver Resection

Open Liver Resection is Also Know as Open Liver Surgery. Visit our Tampa Liver surgery Center Today.

Tampa liver surgeonLiver resection is a curative management for primary liver tumors (hepatocellular carcinoma, cholangiocarcinoma, gallbladder cancer (+/- involving the liver), liver angiosarcoma, etc) and it is the only hope for cure in many metastatic liver tumors (metastatic colorectal cancer, neuroendocrine carcinoma, sarcoma, ovarian cancer, kidney cancer, etc). In the past decade, safety of liver resection has significantly improved with better understanding of liver anatomy, improved surgical instrumentation, and more sophisticated postoperative care. Mortality rate from a major liver resection is now less than 1%. Today, liver resection has become a safe and routine operation, undertaken in many liver surgery/liver cancer centers for benign and malignant tumors, such as in our liver surgery center.

More than 98% of liver resections in United States are undertaken using the traditional open technique. Most patients spend 5-7 days in hospital after the operation. In an effort to further decrease the postoperative complications and to facilitate a shorter recovery, minimally invasive liver surgery technique was developed. In 1992, laparoscopic liver resection was first described for a small peripherally located liver tumor. Laparoscopic liver resection technique gradually evolves to enable completion of major liver resections (removing 3 or more liver segments) for liver cancers. However, not every patients are candidate for the minimally invasive liver surgery based on their tumor characteristics. In about 15% of patients presenting to our liver surgery center require an open liver resection due to tumor size, tumor proximity to major biliary and vascular structures, and the need for a vascular resection with reconstruction. For example, if the liver tumor involves a major blood vessel feeding the liver (main portal vein, hepatic artery, and inferior vena cava) where a vascular resection is needed to achieve cure, then this operation is performed using the traditional open technique.

For open liver resection, a surgical retractor is placed to properly expose the liver and the tumor, away from other abdominal organs such as stomach, intestines, and colon. The blood vessels feeding the lobe of the liver to be resected are carefully isolated and ligated. The line of demarcation on the liver surface is then identified. Liver ultrasound is routinely used to mark the border between the tumor and healthy liver parenchyma. A careful review of the intrahepatic anatomy to map the location of major vessels is crucial for a safe liver surgery. A computerized assessment of the liver volume (to be resected and to be preserved) is equally important to avoid a postoperative liver failure from not having adequate liver tissue after the resection. An experienced liver surgeon determines whether a preoperative portal vein embolization or portal vein ligation to induce future liver remnant hypertrophy is necessary in cases of marginal liver volume. Other factors such as history of chemotherapy, background liver cirrhosis, degree of liver steatosis, obesity, portal hypertension, ongoing biliary obstruction, and prior liver resections are all taken into consideration. This evaluation process is highly complexed, specialized and only available in dedicated liver surgery centers. Majority of community hospitals do not have this type of expertise and capabilities.

Intraoperative bleeding is carefully managed and minimized to achieve superior outcomes. The resected specimen is finally sent to pathology laboratory for a frozen section examination, in order to confirm absence of tumor cells at the liver resection margins. In a small number of patients, a concomitant bile duct resection with reconstruction is necessary (secondary to a direct tumor invasion) to gain a complete cancer removal. Once the open liver resection is complete, your liver surgeon may leave a small drain, which is later removed in a few days after the liver operation or during follow-up visit in the office. Open liver resection is technically challenging and physically demanding for the liver surgeon. It is therefore very important to see a liver specialist or liver surgeon with significant experience in liver resections, especially for the Major liver resections.

Most patients stay in the hospital for 5-6 days after open liver resections. We only admit patients to the intensive care unit when it is clinically necessary.
Nearly all our postoperative liver surgery patients are admitted to a regular surgical floor. Our team of highly-trained nurses, physician assistants, physical therapists, respiratory therapists, and nutritionists will work with you to speed up your postoperative recovery. We also employ an enhanced recovery protocol after Open Liver Surgery to facilitate recovery and shorten the hospital stay.

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With Dr. Iswanto Sucandy, MD
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