Liver-sparing operation associated with higher survival rates in cancer patients

A surgical approach in which a surgeon removes less than a lobe of the liver in a patient undergoing an operation for liver cancer is associated with lower mortality and complication rates, according to new study results published online as an "article in press" in the Journal of the American College of Surgeons (JACS). The article will appear in print in the April issue of the Journal.

Historically, the most common surgical method of treatment for liver cancer was a major hepatectomy in which a lobe (hemi-liver) is removed in order to remove the tumor. The five-year survival rate of selected patients who undergo a complete resection is as high as 50 percent, yet many people aren't operated on because of the high complication rate, blood loss, and liver dysfunction associated with a major hepatectomy.

However, over the last 20 years liver operations have become safer and more effective due to advances in surgical and anesthetic techniques and operating room devices; improvements in perioperative patient care; and a much wider availability of surgeons who are trained in liver surgery techniques.

When a patient has a single tumor, or tumors confined to one side of the liver, a surgical approach called hepatic parenchymal preservation is far better for the patient than the traditional approach of removing large sections of the liver.

This preservation procedure involves removing less than a lobe of the liver without compromising principles of cancer surgery. It places less physical stress on the body, and gives patients a quicker recovery time and the option to have another operation if the cancer recurs.

"The majority of patients with metastatic colorectal cancer are never sent to a liver surgeon because of the impression that a liver operation is too dangerous and patient outcomes are poor," according to T. Peter Kingham, MD, FACS, lead study author and a surgeon at Memorial Sloan Kettering Cancer Center (MSKCC) in New York City. "But we've shown that it's possible to do safe liver resection, so patients should be considered for hepatic parenchymal preservation."

Your liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Primary liver cancer starts in the liver. Metastatic liver cancer starts somewhere else and spreads to your liver.

Risk factors for primary liver cancer include

Having hepatitis B or C
Heavy alcohol use
Having cirrhosis, or scarring of the liver
Having hemochromatosis, an iron storage disease
Obesity and diabetes

Symptoms can include a lump or pain on the right side of your abdomen and yellowing of the skin. However, you may not have symptoms until the cancer is advanced. This makes it harder to treat. Doctors use tests that examine the liver and the blood to diagnose liver cancer. Treatment options include surgery, radiation, chemotherapy, or liver transplantation.