Removing the part of the liver that has cancer is only possible if the cancer is detected early enough and has not spread to the blood vessels or outside the liver. The liver also has to be working well. Surgical removal of small tumors (less than 5 centimeters) is the treatment of choice for liver cancer in patients who do not have cirrhosis, which is approximately 5% of the cases in Western countries, and about 40% in Asia. Because persons with liver cancer often do not have symptoms until the disease is advanced, only a small number of liver cancers are found early enough to be removed with surgery.
During the operation, called a resection, the surgeon removes the part of the liver that has the tumor. How much of the liver is removed depends on how well the liver is working, as well as the size, number, and location of the tumors. The remaining healthy tissue takes over the work of the liver and over several weeks, the liver can regrow the missing parts. The time needed to recover after surgery is different for each person.
In the United States, about 90% of people with liver cancer also have cirrhosis. People with cirrhosis can have surgery only if the tumor is small and the liver is working reasonably well. Doctors often use the Child-Pugh Score to find out the extent of the cirrhosis based on specific lab tests and symptoms.
How Cirrhosis Affects the Possibility of Surgery
|Child-Pugh Class||Possibility of Surgery|
|A||Liver working well enough to have surgery|
|B||Less likely to be suitable for surgery|
|C||Surgery typically is not an option|
Risks and Side Effects of Surgery
Liver surgery, like other major surgeries, may include other risks such as infections and complications from anesthesia. You also may feel tired or weak, and may have diarrhea and a feeling of fullness in the abdomen after the surgery. Bleeding after liver surgery is a major concern because a lot of blood passes through the liver at any given time. Also, the liver normally makes proteins that help the blood to clot. If the liver is injured because of cirrhosis, cancer, or the surgery, it may not make enough clotting proteins to stop bleeding. As a result, the blood may not clot properly, possibly leading to serious bleeding problems.