Hepatectomy

If you know or love someone with liver disease, you may feel overwhelmed by the many unknowns that lie ahead. At AHN, our hepatobiliary surgeons’ expertise helps you navigate your complicated health issue.

A hepatectomy, or liver resection, is a surgical procedure involving the removal of all or part of the liver. It's typically performed to treat liver tumors (both cancerous and noncancerous) but can also be used in cases of severe liver damage or for living donor liver transplants.

A hepatectomy is considered when there's a disease or abnormality affecting the liver that can be effectively treated by surgically removing the affected portion. Common reasons include:

• Cancerous liver tumors:
  • Hepatocellular carcinoma (HCC): The most common type of liver cancer, hepatocellular carcinoma often arises from chronic liver disease (cirrhosis).
  • Cholangiocarcinoma: Also called bile duct cancer that originates in the bile ducts within the liver.
  • Metastatic liver cancer: Cancer that has spread to the liver from another part of the body (e.g., colon cancer, breast cancer, lung cancer). In select cases, resection of liver metastases can significantly improve survival.
• Noncancerous liver tumors: If the benign (noncancerous) tumors, including hemangioma and adenoma, are large enough or causing symptoms, a hepatectomy may help. The benign tumor-like Focal Nodular Hyperplasia (FNH) may also require a resection.
• Other liver conditions:
  • Liver abscess: A collection of pus within the liver, usually caused by infection. While often treated with antibiotics and drainage, resection may be necessary in some cases.
  • Liver cysts: Large or symptomatic liver cysts that cause pain or compress nearby structures may be resected (removed or partially removed).
  • Severe liver trauma: In cases of severe liver injury from an accident, surgery may be necessary to remove damaged tissue and stop bleeding.
  • Living donor liver transplantation: A portion of the liver is removed from a healthy living donor and transplanted into a recipient with liver failure. Living donor liver transplants are a specific type of hepatectomy performed on a healthy liver.
  • Bile duct injuries or strictures: In rare cases, if the bile ducts are severely damaged or narrowed, a resection (removing) of the affected liver portion may be necessary as part of the reconstructive surgery.

Types of hepatectomy

The amount of liver removed can vary greatly depending on the size, location, and nature of the lesion or damage. Resections can range from removing a small wedge of tissue to removing an entire lobe of the liver.

Our surgeons choose the most minimally invasive surgery for your treatment. Types of hepatectomy based on extent of resection include:

• Partial hepatectomy: Only a portion of the liver is removed, rather than the entire organ. This is the most common type of hepatectomy performed.
  • A remarkable feature of the liver is its ability to regenerate. After a partial hepatectomy, the remaining liver tissue can grow back to a significant extent, often restoring much of its original function.
• Wedge resection: This takes a small, wedge-shaped piece of liver tissue for removal. It is typically used for small, superficial lesions for biopsies.
• Segmentectomy: The liver is divided into segments based on blood supply. This removes an entire segment.
• Lobectomy: The liver has a right and left lobe. This surgery removes a lobe. 
• Extended hepatectomy: This is the removal of more than one lobe or segment.
• Liver transplantation: Primary treatment option for patients with advanced cirrhosis and primary liver cancer (HCC) and unresectable hilar cholangiocarcinoma (bile duct cancer). Highly selected patients with unresectable liver-only metastatic liver disease may be candidates for liver transplantation.

Why choose AHN for your hepatectomy?

At AHN, we review each case to tailor the right approach for each patient. Whether using a minimally invasive or a more significant approach, your care plan is designed to improve your specific health outcome. Understanding the complexities and challenges of these liver, bile duct, and gallbladder cancers, our multidisciplinary team — including oncologists, hepatologists, surgeons, pathologists, and radiologists — works together to develop personalized treatment plans that aim to achieve the best possible outcomes for each patient. At AHN, you can expect to experience:

• Highly trained specialists: Our surgeons are board-certified and fellowship-trained in hepatology care. This training leads to the effective diagnosis and treatment of many routine and rare conditions affecting the liver and bile duct system.
• Robotics expertise: We successfully treat liver diseases using sophisticated robotic technology. We are one of a few centers in the region treating liver disease in this way. Our surgeons’ skill with robotics allows them to perform complex procedures, such as combined colorectal and liver surgery.

What to expect for a hepatectomy

Before your surgery, you'll meet with the surgeon to discuss the procedure, risks, benefits, and alternatives. You'll undergo a thorough medical evaluation, including blood tests, imaging scans (CT, MRI), and potentially a liver biopsy. An anesthesiologist will also meet with you to discuss anesthesia options and any preexisting conditions. You will be able to access the care team and resources you need to help you feel confident going into surgery.

You'll receive detailed, personalized instructions about what to do and not do before surgery, such as:

• Fasting requirements: Usually you are asked to not consume any food or drink after midnight the night before.
• Medication adjustments: Some medications may need to be stopped or adjusted. Your doctor will give you specific instructions.
• Bowel preparation: In some cases, you may need to cleanse your bowel.
• Instructions on showering: You will use a special antiseptic soap to reduce the risk of infection.
• Hospital admission: You'll typically be admitted to the hospital the day before or the morning of your surgery.

During surgery

You'll receive general anesthesia, meaning you'll be completely asleep during the procedure. Your surgeon will perform the hepatectomy (liver resection) using one of the following approaches:

• Open hepatectomy: A large incision is made in the abdomen.
• Laparoscopic hepatectomy: Several small incisions are made, and the surgery is performed using specialized instruments and a camera.
• Robotic hepatectomy: Similar to laparoscopic, but a robotic system is used to enhance precision.

After the resection, your surgeon closes the incision(s) and may place drains to remove excess fluid.

After surgery

After surgery, your care team will help make you comfortable and will set you up for as successful a recovery as possible. After surgery you may experience:

• ICU monitoring: Immediately following surgery, the patient will likely be monitored in the Intensive Care Unit (ICU) for a day or two.
• Pain management: Pain will be managed with medication (oral or IV).
• Vital signs monitoring: Frequent monitoring of vital signs (heart rate, blood pressure, oxygen levels, etc.).
• Drainage tubes: Drainage tubes may be placed near the surgical site to remove fluids. These will be monitored and eventually removed.
• Early ambulation: Encouragement to get out of bed and walk as soon as possible to prevent complications like blood clots and pneumonia.
• Dietary help: Starting with clear liquids and gradually advancing to solid foods as tolerated.

Hepatectomy recovery

Individual recovery experiences can vary significantly depending on the extent of the surgery, your overall health, and other factors. Typically, while still in the hospital you can expect:

• Continued pain management: Transitioning to oral pain medications.
• Wound care: Regular monitoring and care of the surgical incision.
• Physical therapy: Continued physical therapy to regain strength and mobility.
• Monitoring for complications: Careful observation for any signs of infection, bleeding, or other complications.
• Discharge planning: Education and instructions for home care, medications, follow-up appointments, and potential warning signs.

Once you are home, you will still have support during your recovery. This may look like:

• Rest and activity: Balancing rest with gentle activity is crucial. Avoid strenuous activities, heavy lifting, and excessive exertion for several weeks.
• Pain management: Continue taking pain medication as prescribed.
• Wound care: Follow instructions for keeping the incision clean and dry. Watch for signs of infection.
• Diet: Follow dietary recommendations from the medical team. A healthy, balanced diet is important for healing.
• Medications: Take all prescribed medications as directed.
• Follow-up appointments: Attend all scheduled follow-up appointments with the surgeon and other health care providers.
• Monitoring for complications: Be vigilant for any potential complications such as infection, bleeding, jaundice, or changes in mental status. Contact the medical team immediately if any concerns arise.
• Gradual return to normal activities: Gradually increase activity levels as tolerated. Return to work depends on the type of work and the individual's recovery progress.

Hepatectomy FAQs

Navigating the information and emotions surrounding a hepatectomy can often feel overwhelming. At AHN, we are here to help and provide you with resources that will aid in conversations with your care team. They will be there to help answer your questions and assure that you have the information you need to feel confident in your treatment plan. To get you started, and to help in your discussions, we’ve provided some answers to frequently asked questions patients often ask.

Can you live a normal life after liver resection?

Many individuals can return to a normal or near-normal life after a liver resection. Recovery depends on the extent of the resection, the underlying liver condition, and the individual's overall health. Lifestyle adjustments, such as diet and avoiding alcohol, may be necessary to support liver regeneration and function.

What is the difference between liver resection and hepatectomy?

These terms are often used interchangeably. Both refer to the surgical removal of a portion of the liver. "Hepatectomy" is the more formal, medical term, while "liver resection" is a more general term.

What is the survival rate for a hepatectomy?

Survival rates following hepatectomy vary significantly based on factors such as the reason for the surgery (e.g., cancer, benign tumor), the size and location of the tumor and the overall health of the patient. It's essential to discuss specific survival expectations with a qualified medical professional who can assess the individual's unique situation.

What are the complications of a hepatectomy?

Potential complications of hepatectomy can include:

• Bleeding
• Infection
• Liver failure
• Bile leakage
• Blood clots
• Pneumonia
• Reactions to anesthesia

Does liver grow back after hepatectomy?

Yes, the liver has a remarkable ability to regenerate. After a partial hepatectomy, the remaining liver tissue can grow back to compensate for the removed portion. The extent of regeneration depends on the amount of liver removed and the health of the remaining liver tissue.

Contact us

Please call (412) DOCTORS 412-362-8677 to schedule a hepatectomy.