Which surgery for liver cancer?

Surgery is the main treatment for primary liver cancer. Unfortunately, for many people it is not possible to remove the cancer with an operation. Surgery can only be considered if the cancer is contained in one area of the liver and has not spread to any other part of the body. This is because the surgery will not cure the cancer if it has already spread.

It is important that your doctor knows how well your liver is working before you have surgery. To get information about this, your doctor will ask you to have a series of blood tests called liver function tests. As the liver is such a vital organ, your doctors need to know that the part of your liver left after your operation will work well enough to keep you healthy. All surgery carried out on the liver is done under general anaesthetic.

It may be possible to remove the cancer and the surrounding tissues in the liver. This is known as a resection. Your surgeon is only likely to consider doing a resection if the cancer is small and if there are no major blood vessels involved.

Sometimes a lobe of the liver may be removed. This is called lobectomy. If you have no underlying medical problems with your liver (such as cirrhosis) it is possible for the liver to grow back and work normally. It is often possible to remove fibrolamellar HCC, as this type of liver cancer is more likely to develop in people with no other liver disease.

Unfortunately, there is a risk that the cancer could come back in the future after a liver resection. There is no test that can guarantee that cancer cells hadn't broken away from the tumour before it was removed. That's why this type of treatment is only used for small liver tumours - where there is less chance of spread.

If you have cirrhosis, you may not have enough healthy liver for your body to cope with removing part of it. Liver failure after a resection or lobectomy is much more likely in people who have cirrhosis. So your specialist may be more likely to consider a transplant if surgery is possible.

Radiofrequency assisted resection involves removing cancer from the liver and treating the area with radiofrequency ablation (RFA). RFA uses high energy radio waves to destroy the cancer and surrounding tissues. The surgeon uses an ultrasound scan to guide the probe to the right place in the liver. The probe destroys the liver tissue around the cancer. Then the dead tissue is surgically removed (resected) with the tumour.

The idea is that heating up the tissues with the RFA probe seals blood vessels so that there isn't as much bleeding as there would be with a standard operation to remove liver cancer. In February 2007 the National Institute for Health and Clinical Excellence (NICE) issued guidance saying that this procedure appears to be safe and works well enough to use on tumours in the liver. But there is a higher risk of getting an infection afterwards. NICE says there isn't enough evidence yet to show that it is any better than other ways of removing liver cancer during an operation.

Transplanting the liver may be possible in some people with hepatocellular liver cancer (HCC). You may be able to have a liver transplant if you have 

• No more than 3 small tumours in your liver, each less than 3cm across
• A single liver tumour up to 5 cm across 
• A single tumour that is 5 to 7 cm across that has been stable (either with or without treatment) for at least 6 months

To have a liver transplant you need a donor liver that is a close match to yours. You may have to wait a long time.

For early primary liver cancer, a liver transplant can be a good treatment option. If the tumours in your liver are too big, a liver transplant will not be an option. But you may be able to have other procedures, such as radiofrequency ablation or chemoembolisation, that will shrink the tumours. Once the tumours are small enough, a liver transplant may then be possible.  

You can usually have a transplant if you have cirrhosis. In fact, that is the main reason for using liver transplants in liver cancer. It is a better option in these situations than resection because you have liver disease in general. But you may not be able to have a liver transplant if you have severe cirrhosis. Your liver specialist has to be sure that you are well enough to get through the operation and recovery period. These risks are higher if you have very severe cirrhosis. You and your specialist will have to talk through all these issues in detail before you both come to a decision about the best course of action.

Some people who have liver cirrhosis, but have good liver function, may be able to have a liver resection if a transplant is not possible for any reason. Resection may be done for liver cancer that has been diagnosed fairly early and has not grown too large within the liver.

A liver transplant is not an option when the cancer has spread out of the liver. Cancer cells elsewhere in the body would be left behind even if the liver was removed. So the surgery would not cure the cancer.

There is more information on liver transplant for liver cancer in this section of CancerHelp UK.