Liver Metastases Surgery

When surgery is possible

Liver resection is possible if:

• the remaining part of the liver is sufficient in volume and has its own blood supply, venous outflow and bile drainage;
• the lesions can be removed completely, with clear margins;
• the primary tumor has already been removed or can be removed;
• there is no uncontrolled spread of the tumor beyond the liver;
• the patient’s general condition allows the procedure.

The number of lesions in itself is not a contraindication. The liver is able to restore its volume, so removal of a considerable part of it is possible — provided that the remnant is sufficient in volume and function.

Most often colorectal metastases are operated on. For metastases from other tumors the decision depends on the type of primary tumor and is made individually.

If surgery is not possible now

This is not always a final conclusion. In such cases the following are used:

• chemotherapy, to shrink the lesions to a size at which resection becomes possible;
• portal vein embolization, so that the healthy part of the liver grows before a major resection;
• staged operations, when the liver is operated on in two sessions with an interval.

After such treatment the examinations are repeated, and the question of surgery is reconsidered. So a conclusion of “inoperable” made six months ago needs to be checked against up-to-date images — this is what a surgeon’s second opinion is for.

Types of operations for liver metastases

How the operation is performed

The extent of the procedure depends on the location of the lesions. When it and the required extent of resection allow, the operation is performed laparoscopically — through several small punctures. This means less surgical trauma, less blood loss and faster recovery, which is important for patients who need to continue chemotherapy after surgery. In other cases the operation is performed openly.

The approach is chosen based on the size and location of the lesions, the extent of the procedure and previous operations. The duration of the operation depends on its extent; I will be able to say more precisely after reviewing the images.

Hospital stay, recovery and further treatment

The length of the hospital stay depends on the extent of surgery and the approach — after a laparoscopic procedure it is usually shorter. Recovery follows the enhanced recovery (ERAS) protocol: early mobilization, early return to eating, controlled pain relief.

If chemotherapy is indicated after surgery, it is started once the wound has healed and liver function tests have returned to normal. The exact timing is determined by a medical oncologist together with the surgeon.

The appearance of a new lesion in the liver over time does not mean that surgical options are exhausted: repeat resection or ablation is possible if the same conditions as for the first operation are met.

Risks and complications

Risks are what patients ask about least often, although they are the most important thing to discuss before surgery. The main ones are:

• liver failure — in particular when the volume or function of the liver remnant is insufficient; this is why both are assessed before surgery and, if necessary, the liver is prepared;
• bleeding during or after the operation;
• bile leak from the resection surface;
• infection and general surgical complications, including thrombosis;
• with ablation — heat damage to the bile ducts or neighboring organs.

The likelihood of each depends on the extent of resection, the condition of the liver after chemotherapy and other conditions. I will explain the risks in your particular case at the consultation.

What the cost depends on

The cost depends on the extent of surgery, the approach, whether resection is combined with ablation, the number of days in the hospital and the tests. The exact amount is named once the treatment plan has been defined. The payment can be split into parts — installments are available. The in-person consultation is free. More details are on the page “Cost of Surgery: What It Depends On”.

Which documents are needed and how to book

• contrast-enhanced CT and MRI discs of the liver — recent and previous ones, the discs with the images;
• the histology report of the primary tumor and, if available, the results of molecular tests;
• treatment records: bowel operations, chemotherapy regimens and number of courses;
• recent blood tests, including liver function tests and tumor markers.

Book a consultation by phone or through the form. If you are from another city, send the documents in advance — how to do this is described on the page “Online Oncologist Consultation”.