Liver & Biliary Cancer Surgery

The operation removes the affected part of the liver, or the bile duct and gallbladder with the liver tissue around them, leaving behind enough working liver to keep you alive while it regrows.

The liver is divided into eight segments, each with its own blood supply and drainage, and a resection follows those planes. A surgeon may take one segment or an entire half. The liver is the one solid organ that regenerates: the remnant enlarges over weeks and recovers most of its function within a few months.

The question that decides whether this operation is possible is not the size of what is being removed but the size and quality of what is left. Your surgeon will calculate the volume of the future remnant from a CT scan and assess how healthy that tissue is, since a liver already scarred by hepatitis or long-standing disease tolerates far less removal than a healthy one. Where the planned remnant is too small, a procedure can be done several weeks beforehand to block the blood supply to the side being removed, which makes the other side grow before the main operation.

Where the bile duct is involved, the drainage of bile has often been obstructed and a stent or a drain is placed first to let the jaundice settle, because operating on a deeply jaundiced patient is more dangerous.

You are admitted a day or two before, and blood is cross-matched because liver surgery can involve significant blood loss.

The operation is under a general anaesthetic and takes three to six hours. Most are done open, through a cut below the ribs, though selected resections are done by keyhole. Your anaesthetist deliberately runs your circulation on the dry side during the dissection, which reduces bleeding from the liver veins, and an epidural is usual for pain relief.

You wake in an intensive care or high-dependency bed and stay there for a night or two while the remaining liver is watched: blood clotting, blood sugar and mental clarity are the measures of how well it is working. Drains and a urinary catheter are normal. Fluids by mouth start early, food within a day or two, and most people are walking by the second day. A stay of five to ten days is usual.

Expect six to twelve weeks to feel yourself again. Tiredness is the dominant symptom in the first month and is out of proportion to what you did that day; it improves steadily as the liver regrows.

The cut below the ribs is sore when you cough, laugh or get out of a chair, and a pillow held against it helps. No lifting over a few kilograms for six weeks. Driving at three to four weeks, desk work at six weeks, physical work at ten to twelve.

Your liver blood tests will be abnormal for several weeks after surgery and that is expected while the remnant is regenerating. Eat normally and well; no special liver diet is needed, though alcohol is stopped completely while the liver rebuilds and permanently if the underlying liver is diseased. Further treatment, where it is planned, generally begins six to eight weeks afterwards, and follow-up scans continue for years.