For patients with early-stage liver cancer, the surgical removal of the tumor provides the best chance of a cure. This therapy is also known as liver resection. What makes resection possible is the liver’s natural ability to regenerate. Surgeons can remove up to 80 percent of the liver and it will grow back in a matter of weeks if the remaining liver is healthy.
Who Is Eligible?
Surgery is a potential treatment for primary and metastatic liver cancers. In recent years, newer surgical technology and improved imaging capabilities have significantly increased the safety of liver surgery and reduced complication rates. These improvements have made liver resection possible for a greater number of patients. However, not all patients are good candidates for liver resection:
Some patients are not eligible for surgery, because their cancer has spread to other organs. In other cases, the size or location of the tumor within the liver prevents safe removal. Patients with underlying cirrhosis or hepatitis or other serious medical conditions may not be candidates for resection. Patients who are ineligible for liver resection are evaluated by a multidisciplinary team for other therapy options, including liver transplant.
On the other hand, strategies are available for expanding the group of patients who are eligible for resection. Initial systemic chemotherapy can sometimes downstage a patient’s liver cancer, making the patient eligible for resection. Portal vein embolization is a procedure that can increase the healthy portion of a patient’s liver, enabling surgeons to safely remove a larger portion of the liver. Two-stage liver resection can be an option for patients with multiple liver tumors in separate lobes of the liver: One lobe is resected and allowed to regenerate; the second lobe is removed during a procedure weeks later.
Surgical Procedures for Liver Cancer
The right surgical approach depends on many factors, including the number, size and location of the patient’s tumors. Surgical oncologists at Froedtert & The Medical College of Wisconsin provide the full range of standard and advanced liver procedures:
Open surgical resection: The surgical oncology team accesses the liver through a standard surgical incision to remove one or more tumors. An ultrasound probe is used during the procedure to verify tumor location so the surgeon knows where to divide the liver tissue. The probe is also used to search for other tumors that may not have been detected in pre-operative scans. Specific resection procedures include segmentectomy (removal of a segment of liver tissue), lobectomy (removal of an entire lobe of the liver) and trisegmentectomy (an extensive surgery to remove up to 80 percent of the organ).
Laparoscopic liver surgery: Depending on tumor type, location and other factors, some patients may be eligible for a minimally invasive liver resection. Working through three to five small incisions, the surgical team uses laparoscopic tools to remove tumors. The benefits of this approach include less post-operative pain, shorter hospital stay and faster recovery. Minimally invasive resection may be an option for some patients with colorectal cancer that has metastasized to the liver. Surgical oncologists at Froedtert & The Medical College of Wisconsin have pioneered laparoscopic approaches to liver resection.
Ablation: For select patients, tumor tissue may be destroyed using cold or heat energy:
Microwave ablation: Uses the heat-producing power of microwave energy to destroy cancerous tumors. A probe-like antenna inserted into the center of a tumor transmits electromagnetic waves, which cause water and other molecules within the tumor to vibrate many thousands of times a second. This action generates friction and heat that kill cancer cells. Surgeons may employ microwave ablation intra-operatively (as part of an open surgical procedure), laparoscopically (through small incisions), or percutaneously (through the skin).
Cryoablation: A metal tube is placed into the tumor using ultrasound guidance. The tube is then cooled to -190° C (-360° F). The tumor is engulfed in an ice ball, resulting in the death of tumor cells.
Radiofrequency ablation (RFA): A needle electrode is placed in the tumor under the guidance of ultrasound or CT imaging. A radiofrequency current is passed through the electrode to heat the tumor tissue near the needle tip. The heat destroys the tumor and also seals small blood vessels, minimizing the risk of bleeding.
Ablations can be performed as part of an open surgical procedure or a laparoscopic (minimally invasive) surgery. In some cases, superficial tumors can be resected, while deeper tumors are destroyed by ablation, thereby preserving most of the liver tissue.
Selective ablations can also be performed on an outpatient basis in the Radiology Department. For more information, see IR therapies for liver cancer.
Combined Liver/Colon Surgery
Some patients with colon cancer that has spread to the liver can undergo combined colon/liver surgery. Colorectal surgeons and liver surgeons work together in a coordinated fashion during a two-part operation to remove diseased portions of the colon, as well as liver tumors. To learn more, visit our Colorectal Cancer Program section.
Isolated Liver Perfusion
Some difficult cases of liver cancer can be treated with isolated liver perfusion, a surgical procedure in which high doses of chemotherapy are delivered directly to the liver. Because of the complexity of this procedure, it is reserved for advanced liver cancers that cannot be treated with other methods. To learn more about isolated liver perfusion, visit our Regional Cancer Therapy Program section.