Liver Resection

Liver resection is the removal of a part of the liver by surgery. Up to 2/3 of your liver can be removed as long as the rest of the liver is healthy.

This operation is mainly to treat liver cancer, certain at risk tumors and selected secondary cancer (e.g. colorectal). Sometimes, liver surgery can be performed for benign conditions like liver abscess and symptomatic liver cysts.

Types of Liver Resections

Historically, liver resections were performed with long cuts on the abdomen. Currently in SGH, about 50% of our liver resection procedures are done with a minimally invasive approach (laparoscopic/robotic). This lessens the pain, minimizes the scar and allows a faster recovery. Your surgeon will discuss with you if a minimally invasive approach is suitable for you.

Depending on the tumour and patient factors, liver resection can be in the form of conventional open surgery,

or keyhole access (laparoscopic or robotic) surgery. If the right side of your liver is removed, your gallbladder (attached to the liver) may also be removed. In some patients, the bile duct may need to be removed and subsequently connected to the intestine with a joint (anastomosis). Your doctor will explain in detail which type of surgery you will have. This operation typically takes 2 to 6 hours to perform, or more depending on the complexity of the surgery and its approach. Your surgeon may close your incision with staples, sutures (stitches), or glue.

If a large portion of the liver needs to be removed or if the remaining liver is unhealthy, there is a chance of  developing liver insuffciency or failure.

Bleeding during/after surgery. Blood transfusion may be required if bleeding occurs.

Bile leak can occur either from the cut liver surface or from a joint (anastomosis) between the bile duct and a loop of intestine.

Other possible problems include wound and intra-abdominal infections, injury to other organs, blood clots in the lung, urinary tract and lung infections. Precautions will be taken by the surgeons to minimise these complications as far as possible e.g. prophylactic antibiotics, calf compressors etc.

You will be informed on the recovery process and pain  management more specically by a medical professional. Early oral intake and ambulation is encouraged during recovery.

There are other treatments possible for liver cancer:

Ablation – This treatment destroys liver tumours without removing them. Suitable as rst line treatment for a small tumour via a thin, needle-like probe which heats the tumour using high energy radio waves (Radiofrequency Ablation) or microwave energy (Microwave Ablation).

Embolisation – Chemotherapy drugs (Transarterial Chemoembolisation) or radioactive beads (Selective Internal Radiation Therapy) administered via a feeding

blood vessels through the groin. The drugs are delivered directly to the liver tumours to decrease the size of the tumours.

Systemic Therapy – Targeted drugs work by interfering with specic abnormalities within a tumour. They have been shown to slow or stop advanced liver cancer from progressing for a few months longer than with no treatment.

External Beam Radiotherapy (EBRT) – A treatment utilizing non-invasive photon or particle radiation, delivered to control the symptoms of a tumour for the short term. For more radical indications such as longer term control of localized unresectable cases, Stereotactic Body Radiotherapy (SBRT), which can deliver a higher dose of radiation may be used.

Liver Transplant – If the patient is deemed suitable and within the liver transplant criteria, a donor provides a full or partial liver to replace the diseased liver in another person. There are 2 types of transplant. Deceased Donor Liver Transplant (DDLT) where the donated liver come from people who have died suddenly from an accident or bleeding into the brain; and Living Donor Liver Transplant (LDLT) which involves a living donor giving a portion of his or her liver to a family member in need of a liver transplant.

It is also the national referral centre for Haematology, Renal Medicine, Nuclear Medicine, Orthopedic Surgery, Pathology and Plastic Surgery (Burns).

As an academic healthcare institution, SGH provides postgraduate training and plays a major role in undergraduate training and clinical teaching for medical professionals locally and in the region. It is also committed to innovative translational and clinical research to provide the best possible care for patients.