Liver resection surgery is a surgical procedure that involves removing part or all of the liver tissue to treat liver diseases. It is primarily used to eradicate malignant tumors, benign tumors, or severely damaged liver tissue to prevent disease spread or organ failure. This surgery can be classified into open and minimally invasive types, with the most suitable approach selected based on the patient's condition and the physician's judgment.
The aims of the surgery include directly removing malignant tumors to prolong patient survival or excising benign tumors (such as hepatic adenomas) that obstruct liver function. Advances in minimally invasive techniques in recent years have significantly improved surgical trauma and recovery time, making it the preferred option for treating malignant liver tumors.
Liver resection mainly divides into anatomical resection (segmental removal based on hepatic vasculature and bile ducts) and non-anatomical resection (direct removal of tissue surrounding the tumor). Minimally invasive procedures such as laparoscopic or robot-assisted liver resection use small incisions to insert endoscopic instruments, reducing tissue damage and accelerating recovery.
The mechanism involves completely removing diseased tissue while preserving enough healthy liver tissue to maintain metabolic function. The remaining liver tissue will regenerate post-surgery, but it is essential to assess whether the patient's liver function can support regeneration to avoid the risk of liver failure.
Suitable for primary liver cancer (such as hepatocellular carcinoma), metastatic liver cancer, large benign tumors (like hepatic hemangiomas), or cases with recurrent infections caused by intrahepatic bile duct stones. When tumors have not metastasized and the patient's liver function is Child-Pugh grade B or below, it is considered an indication for surgery.
Other conditions include liver cysts compressing vital structures, extensive trauma causing large liver damage, or certain hereditary liver diseases (such as hepatic adenomas). Tumor boundaries must be confirmed through imaging and pathology to ensure complete resection is feasible.
The surgery requires general anesthesia and is categorized into partial liver resection (removing part of a lobe or segment) or total liver resection (rare, usually combined with liver transplantation). Laparoscopic surgery involves 3-4 small incisions, while open surgery requires an abdominal incision of 10-20 centimeters.
There is no concept of "dosage," but the extent of resection must be precisely calculated. Surgeons use preoperative 3D imaging simulations to ensure residual liver volume is sufficient (usually at least 30% of healthy tissue) to prevent postoperative liver failure.
Compared to liver transplantation, this surgery does not require waiting for a donor organ and avoids the use of immunosuppressants. For early-stage liver cancer patients, the postoperative local recurrence rate is low, making it a key curative treatment option.
Main risks include massive bleeding, liver failure, and bile leakage. Postoperative complications may include intra-abdominal infection, thrombosis, or coagulation abnormalities caused by liver tissue damage. About 5-10% of patients may experience residual liver syndrome, leading to acute liver failure.
Short-term side effects include pain, diarrhea, or nutritional absorption issues. Long-term effects may impact coagulation function or cause metabolic abnormalities. Elderly patients or those with pre-existing liver dysfunction are at higher risk of complications and require close monitoring.
Contraindications include Child-Pugh C liver function, extensive metastatic tumors, uncontrolled coagulation disorders, or systemic failure unable to tolerate anesthesia. Preoperative assessment of cardiac and pulmonary function, as well as the relationship between the tumor and major blood vessels, is necessary.
Postoperative care includes avoiding alcohol and hepatotoxic drugs, with regular follow-up of alpha-fetoprotein levels and imaging examinations. Diabetic patients should control blood sugar levels, as hyperglycemia can delay wound healing.
Often combined with preoperative chemotherapy (neoadjuvant therapy) to shrink tumors for easier resection. Postoperative treatments may include radiotherapy or targeted drugs to reduce recurrence risk. Patients on anticoagulants need dosage adjustments to prevent intraoperative bleeding.
When combined with liver transplantation, tumor characteristics must meet Milan criteria. If combined with radiotherapy, attention should be paid to the additive effects of radiation-induced liver damage and surgical trauma.
For early hepatocellular carcinoma, liver resection achieves a 5-year survival rate of 60-70%, significantly higher than non-surgical treatments. Large studies show that laparoscopic liver resection has comparable tumor control to open surgery but with a 30% lower complication rate.
Radical resection offers better recurrence-free survival (RFS) than local ablation therapies. The liver's regenerative capacity is strong; if the resection is moderate, the residual liver can compensate within weeks.
Patients unable to undergo surgery may opt for radiofrequency ablation (RFA) or transarterial chemoembolization (TACE), though these have higher local recurrence rates. Chemotherapy embolization is suitable for multiple small tumors but cannot completely eliminate lesions. Liver transplantation is an option for metastatic tumors but requires strict criteria and long waiting times.
Palliative treatments such as radiotherapy or immunotherapy can be used for unresectable tumors but cannot replace the curative effect of surgery. The choice of alternative depends on tumor staging and overall patient health.
What preparations are necessary before surgery to ensure a smooth liver resection?
Patients should undergo general anesthesia assessment, liver function tests, and imaging examinations (such as CT or MRI) to confirm the extent of liver lesions and vascular distribution. Preoperative adjustment of anticoagulant medications and bowel preparation as per medical instructions are also required to reduce surgical risks.
What are the postoperative pain management methods after liver resection?
Initial postoperative pain may be controlled with patient-controlled analgesia (PCA), transitioning to oral pain medications later. Physical therapy-guided deep breathing exercises are recommended to relieve chest pain and prevent pulmonary complications. Patients should avoid breath-holding or strenuous activity to reduce abdominal tension.
How should diet be adjusted post-surgery to promote recovery?
During the first week, a liquid or semi-solid diet such as rice porridge or steamed fish congee is recommended, with small frequent meals. After 2-4 weeks, high-protein foods (like quality fish and soy products) should be gradually introduced to repair tissues, while high-fat and fried foods should be avoided to reduce liver metabolic burden. Regular monitoring of liver function tests is necessary to adjust dietary plans accordingly.
How is the risk of recurrence after liver resection evaluated and monitored?
Doctors develop follow-up plans based on the nature of the primary disease (malignant tumor or benign cyst). Usually, ultrasound or tumor marker blood tests are performed every 3-6 months postoperatively, with higher frequency in the first two years. Patients with a history of cirrhosis require closer monitoring of portal hypertension and liver function abnormalities.
How long after surgery can patients resume daily activities? When can they return to exercise?
Typically, patients can be discharged after 5-7 days of hospitalization, but full recovery of daily activities takes 4-6 weeks. Light walking is recommended in the first two weeks, avoiding lifting heavy objects or vigorous exercise for three months. Aerobic activities like jogging usually require waiting 3-6 months and should be gradually increased under the guidance of a rehabilitation specialist based on liver function recovery.
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