Resection
Patient
Selection Criteria
Patients who fit the criteria for resection (surgical removal) generally
have disease only in the liver. About 20% of patients with liver cancer
are candidates for resection. Patients with medical problems or associated
conditions (other than the liver disease) that might limit their life
expectancy are generally not considered candidates for resection. This
includes those people whose tumors are in a location that is not conducive
to resection (where resecting a 1 cm margin of healthy tissue around
the tumor is not possible), or whose tumors are near to or are invading
major vascular structures. Additionally, patients with very large tumors,
many tumors, or severe cirrhosis are often not candidates for resection
because the surgery would leave them without enough healthy liver.
Description
of Procedure
Liver resection
is a major surgical operation using general anesthesia and requiring
a large incision in the abdomen. The purpose of the resection is to
remove (cut out) each tumor and a margin of healthy tissue around it.
The number of tumors and their location determines the amount of liver
to be removed, which can range from 3% to 85% of the liver. The surgeon
first evaluates the patient to confirm that resection is appropriate;
i.e. that there are no other unexpected lesions outside the liver and
that the number and size of lesions within the liver is still within
the acceptable criteria. After controlling the blood flow into and out
of the targeted portions of the liver, the surgeon resects/removes the
diseased parts of the liver.
Risks/Side
Effects/Complications
Mortality
rates for patients undergoing liver resection range from 1.2% to 5%.
Some type of morbidity or complication occurs in 13 to 39% of patients.
These complications could include, but are not limited to, any of the
following:
- Hemorrhage
- Postoperative
liver failure
- Renal
insufficiency (kidney)
- Abscess
- Biliary
fistula
- Bile
leakage
- Wound
infection
- Pneumonia
- Pleural
effusion
- Ascites
- Coagulopathy
- Small
bowel obstruction
- Gastrointestinal
tract fistula
- Portal
vein thrombosis
- Adult
respiratory distress syndrome
Recovery
time and lifestyle changes
The hospital
stay after a resection ranges from 6.5 to 15 days. The longer stays
are usually associated with complications. Because this is an open procedure
and general anesthesia is used, there are some short-term lifestyle
changes. The abdominal incision wound needs to be cleaned 3 times per
day for about the first 2 weeks post-op. It is also generally recommended
that patients not drive for at least 2 weeks after this surgery. In
addition, patients are usually advised to limit their physical activity
and not to do any heavy lifting for up to 3 months after surgery.
Effectiveness
HCC studies
done in Western countries have shown 5-year survival rates after resection
of 27% to 49%, while studies from the Asian Pacific rim report 5-year
survival rates of 10.7% to 39%. Survival tends to be better for patients
with small tumors (less than 5 cm in diameter) than for those with large
tumors (greater than 8 cm in diameter). Similarly, survival tends to
be better for patients without cirrhosis than those with cirrhosis.
Recurrence rates range from 45% to 70%, most of these occurring within
the first 2 years after resection.
In colorectal
metastases to the liver, 5-year survival rates range from 22% to 60%.
Survival tends to be better for patients with disease confined to the
liver, and with four or fewer lesions. These lesions must be able to
be resected with at least a 1 cm tumor-free margin, leaving an adequate
amount of healthy liver tissue remaining.
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2001 RITA Medical Systems, Inc. | Contact Us | Disclaimer
| Last modified: Friday, October 10, 2003
