Surgery for Liver & Bile Duct Cancers
Doctors at NYU Langone’s Perlmutter Cancer Center may surgically remove liver tumors that are limited to a specific area of the organ and when cancer has not spread. Surgery is usually the most effective treatment for early liver cancer. To withstand surgery, the liver needs to be healthy enough to maintain its normal functions afterwards. If mild scarring, called fibrosis, or severe scarring, called cirrhosis, is present, then liver function in the tissue remaining after surgery must be adequate.
Imaging Before Surgery
Doctors may use CT or MRI scans to plan surgery. These imaging studies provide detailed views of the liver, surrounding blood vessels, and other structures and can help doctors pinpoint the location of the tumor or tumors.
Doctors may also perform a cholangiogram, a type of X-ray that creates images of the bile ducts. Just before the X-ray, your doctor injects a contrast agent through a small tube, called a catheter, into a bile duct. Detailed pictures of the liver, the bile ducts, and the tumor can help your doctor plan appropriate treatment.
Surgical resection is often the most effective therapy to treat liver and bile duct tumors. Perlmutter Cancer Center doctors may recommend surgically removing liver cancer or cancer that has spread from another organ, such as the colon.
For a tumor found in the outer portion of the liver, surgeons may remove one of the eight segments that comprise the organ. These segments are divided by branches of the portal vein, a major vessel that supplies blood to the liver from the intestinal tract and the spleen. A wedge resection—in which the tumor is removed along with some surrounding liver tissue instead of an entire segment—may also be an option.
Doctors may manage large tumors and cancers that are centrally located in the liver differently than small tumors. Surgeons may remove more than one small segment of the liver or a larger portion, called a lobe.
After the cancerous portion of the liver is removed, the remaining healthy tissue grows to help restore normal function. This regrowth can occur in as little as two to three weeks.
Liver surgery can be complex, because the organ contains many important blood vessels. For example, after the portal vein brings blood to the liver, the blood leaves the organ through hepatic veins to the major vein in the abdomen that returns blood to the heart. NYU Langone surgeons are skilled in removing cancer while protecting important arteries and veins, preserving as much healthy tissue as possible.
For people with metastatic liver tumors—cancer that has spread from other organs—chemotherapy is administered before surgery to help reduce the size and prevalence of tumors. It is sometimes combined with targeted medications to shrink tumors.
For most people, liver resection surgery does not require a stay in the intensive care unit. People typically remain in the hospital for five to seven days after open surgery, and three to four days after laparoscopic surgery.
Our doctors perform several different types of liver surgery. They use minimally invasive approaches whenever possible.
At Perlmutter Cancer Center, many liver resection procedures can be performed laparoscopically, through several small incisions in the abdomen. A laparoscope, which is a lighted tube with a tiny camera on it, is placed through one of the incisions to view the liver, and other instruments are used to remove the cancerous portion of the liver.
In many cases, laparoscopy means smaller incisions, less discomfort, and a quicker recovery.
Open surgery may be recommended for large tumors or those that are located deep within the liver. In an open procedure, a doctor makes an incision that is several inches long across the right side of the abdomen, below the ribcage.
The hospital stay after any type of liver surgery may be five to seven days. Doctors and nurses manage any pain and monitor for signs of infection. Full recovery from surgery may take up to six weeks or longer.
Portal Vein Embolization
Sometimes, problems with liver function after surgery for liver cancer are a concern. In that case, our surgeons may work with interventional radiologists before surgery to measure the liver’s volume and, if necessary, perform a preventive procedure called a portal vein embolization. This increases the size of the portion of the liver that remains after surgery.
In this procedure, doctors embolize, or cut off, the blood vessel nearest the tumor to encourage the other side of the liver to grow before surgery. It takes several weeks for the liver to grow. A portal vein embolization can allow people who were not candidates for surgery to have a liver resection, in which parts of the organ are removed.