Patient Selection Criteria
Patients who fit the criteria for resection (surgical removal) generally have disease only in the liver. About 20% of patients with liver cancer are candidates for resection. Patients with medical problems or associated conditions (other than the liver disease) that might limit their life expectancy are generally not considered candidates for resection. This includes those people whose tumors are in a location that is not conducive to resection (where resecting a 1 cm margin of healthy tissue around the tumor is not possible), or whose tumors are near to or are invading major vascular structures. Additionally, patients with very large tumors, many tumors, or severe cirrhosis are often not candidates for resection because the surgery would leave them without enough healthy liver.
Description of Procedure
Liver resection is a major surgical operation using general anesthesia and requiring a large incision in the abdomen. The purpose of the resection is to remove (cut out) each tumor and a margin of healthy tissue around it. The number of tumors and their location determines the amount of liver to be removed, which can range from 3% to 85% of the liver. The surgeon first evaluates the patient to confirm that resection is appropriate; i.e. that there are no other unexpected lesions outside the liver and that the number and size of lesions within the liver is still within the acceptable criteria. After controlling the blood flow into and out of the targeted portions of the liver, the surgeon resects/removes the diseased parts of the liver.
Mortality rates for patients undergoing liver resection range from 1.2% to 5%. Some type of morbidity or complication occurs in 13 to 39% of patients. These complications could include, but are not limited to, any of the following:
- Postoperative liver failure
- Renal insufficiency (kidney)
- Biliary fistula
- Bile leakage
- Wound infection
- Pleural effusion
- Small bowel obstruction
- Gastrointestinal tract fistula
- Portal vein thrombosis
- Adult respiratory distress syndrome
Recovery time and lifestyle changes
The hospital stay after a resection ranges from 6.5 to 15 days. The longer stays are usually associated with complications. Because this is an open procedure and general anesthesia is used, there are some short-term lifestyle changes. The abdominal incision wound needs to be cleaned 3 times per day for about the first 2 weeks post-op. It is also generally recommended that patients not drive for at least 2 weeks after this surgery. In addition, patients are usually advised to limit their physical activity and not to do any heavy lifting for up to 3 months after surgery.
HCC studies done in Western countries have shown 5-year survival rates after resection of 27% to 49%, while studies from the Asian Pacific rim report 5-year survival rates of 10.7% to 39%. Survival tends to be better for patients with small tumors (less than 5 cm in diameter) than for those with large tumors (greater than 8 cm in diameter). Similarly, survival tends to be better for patients without cirrhosis than those with cirrhosis. Recurrence rates range from 45% to 70%, most of these occurring within the first 2 years after resection.
In colorectal metastases to the liver, 5-year survival rates range from 22% to 60%. Survival tends to be better for patients with disease confined to the liver, and with four or fewer lesions. These lesions must be able to be resected with at least a 1 cm tumor-free margin, leaving an adequate amount of healthy liver tissue remaining.
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