Liver Resection

What you should know

• Liver resection is surgery to remove an area of your liver. Your liver is an organ that lies in the upper right side of your abdomen (stomach). Your liver has many functions including removing waste products from your blood. It breaks down your blood so your body can better use the nutrients. Your liver also helps control your blood clotting. The liver has a right and a left lobe, and can be divided into eight segments. The liver is the only organ in your body that can renew itself.
  
  
• The most common reason for a liver resection is to remove liver cancer or liver metastases. Metastases are cancer cells that have spread to your liver from another area of your body. Liver resection also may be done for noncancerous liver problems. Some people choose to donate a part of their healthy liver to someone who needs a liver transplant. Ask your caregiver for more information about live liver donation.
  
  
• Before having a liver resection, imaging tests are done to help plan your surgery. You also will need tests to check the function of your liver. The amount of your liver that will be removed depends on where the diseased areas are found. Because the liver can renew itself, over half of your liver can be removed if needed. During surgery, your caregiver will check for other diseased areas not found before surgery. Having a liver resection may decrease symptoms of liver problems such as abdominal pain and yellowing skin. If you have cancer, it may prevent it from spreading. A liver resection may even cure your cancer.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

Risks

• You may have an allergic response to the medicines used during, and after your surgery. The fluids used during your surgery may build up in your abdomen and lungs. Extra fluid may make it hard for you to breathe. If you have cancer, when your tumor is removed cancer cells may spill out and form a new tumor. Even if your cancer is removed, it may come back, and you may need another liver resection. During surgery, your blood vessels may be damaged, and you may lose large amounts of blood. Air may also enter your blood vessels which could be life-threatening if it enters your heart.
  
  
• After surgery, bile may leak from your bile ducts into your abdomen. You may get a wound, abdominal, or lung infection. You may also have an abscess (pus pocket) form in your abdomen. You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs. A blood clot in your lungs can cause chest pain and trouble breathing. This problem can be life-threatening. Your lungs and heart may not function as they should, and you may have a heart attack. The remaining area of your liver may fail, and you may die.
  
  
• Without surgery, your symptoms, such as jaundice and poor nutrition, may worsen. If you have cancer in your liver, the cancer may spread to other areas of your body. Your liver function may worsen causing your liver to fail, and you may die. Ask your caregiver if you have questions or concerns about your condition, surgery, or care.

Getting Ready

Before your surgery:

• Ask someone to drive you home when you are ready to leave the hospital. Do not drive yourself home.
  
  
• Bring your medicine bottles, or a list of all your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine, or if you are taking herbs or food supplements. Ask your caregiver if you need to stop using aspirin, prescribed, or other over-the-counter medicine before your surgery.
  
  
• Tell your caregiver if you are, or have been getting chemotherapy. Your caregiver may wait to do your surgery for up to eight weeks after getting chemotherapy. Waiting may help decrease any problems you may have after your surgery.
  
  
• Your caregiver may put you on a low-fat, high protein diet if you have fat deposits in your liver. You may need to be on this diet for a few weeks before your surgery. Ask your caregiver for more information about any diet changes you may need.
  
  
• Certain liver problems may make it hard for you to eat, and you may lose weight. You may need IV liquid nutrition if you are unable to eat enough before your surgery. An IV is a tube that is placed in your vein for giving liquids and medicines. The liquid provides your body with nutrition such as protein, sugar, vitamins, minerals, and sometimes fat (lipids).
  
  
• You may need to have biliary drainage done before your surgery if you are jaundiced. Jaundice occurs when too much bilirubin is made in your body. Bilirubin is a yellowish fluid that is made when your liver breaks down old red blood cells. Your skin and the whites of your eyes may turn yellow. Biliary drainage is done to decrease your bilirubin levels to normal before your surgery. Ask your caregiver for more information about biliary drainage.
  
  
• You may need to have portal vein embolization 2 to 4 weeks before your surgery. Your portal vein is a large blood vessel that carries blood to your liver. Your caregiver may block the vein to see how well the healthy part of your liver functions. By doing this, you and your caregiver can learn if the liver that will be left can function on its own.
  
  
• You may need to have a computed tomography (CT) scan, magnetic resonance imaging (MRI) or a positron emission tomography (PET) scan. You also may need an abdominal ultrasound and a chest x-ray. These tests can help your caregiver plan your surgery and check for disease outside your liver. The tests also may be done to check the function of the liver area that will not be removed. Blood tests will be done to check the function of your liver and other organs. You may need a colonoscopy and upper gastrointestinal endoscopy to check for any problems or disease. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location, of each test.

The night before your surgery:

• Ask caregivers about directions for eating and drinking.
  
  

The day of your surgery:

• Write down the correct date, time, and location of your surgery.
  
  
• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• You or a close family member will be asked to sign a legal document called a consent form. It gives caregivers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.
  
  
• Antibiotics: You may be given antibiotics through your IV before your surgery. Antibiotics help prevent infection from bacteria called germs.
  
  
• Arterial line: This is a tube placed into an artery (blood vessel), usually in your wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line measures your blood pressure and may be used for taking blood.
  
  
• Central venous pressure line: A central venous pressure (CVP) line is a thin tube put in a vein near your collarbone, or in your neck or groin. The CVP line can monitor the fluid and pressure in your blood vessels. The CVP line also may be used to give medicines or fluids.
  
  
• Blood transfusion: You may need a transfusion during surgery if you lose a large amount of blood. During a blood transfusion, you will get whole blood, or parts of blood through an IV. You also may need a blood transfusion after your surgery. Ask your caregiver for more information about receiving blood.

Treatment

What will happen:

• You will be taken to the room where your surgery will be done. You will lie on your back on the surgery table. Anesthesia medicine will be given to you to keep you asleep and pain free during your surgery. Your caregiver will make an incision (cut) in your abdomen just below your ribs. Muscles and other tissues will be moved aside to help see your liver better. An ultrasound may be done during surgery to look for unknown areas of disease. If the right side of your liver is being removed, your gallbladder also will be taken out. Clamps may be used to stop the blood flow through your liver during surgery. The blood vessels attached to the area to be removed will be cut and closed to stop any bleeding.
  
  
• Your caregiver will remove one or more segments of your diseased liver. Sometimes, only a wedge (portion) of a liver segment needs to be removed. The clamps will be removed so blood can flow through the remaining part of your liver. Your caregiver may use stitches, special glue, or a laser beam to stop any areas of bleeding. Your cut will be closed with stitches, or tissue glue and covered with a bandage. The liver tissue that was removed may be sent to a lab for tests.

After your surgery:

You will be taken to a room where you can rest until you are fully awake. Do not get out of bed until your caregiver says it is okay. A caregiver may remove your bandages soon after your surgery to check your wound (surgery site). When caregivers see that you are not having any problems, you will be taken to your hospital room.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Contact a caregiver if

• You cannot make it to your surgery.
  
  
• You get sick with a cold or the flu.
  
  
• You have a fever.

Seek Care Immediately if

• You feel very weak or get tired easily.
  
  
• You have a decreased appetite for food and are losing weight.
  
  
• You have new or worsening yellowing of your skin, or the whites of your eyes.
  
  
• You have severe (very bad) pain in your upper abdomen.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.