Hepatectomy

A hepatectomy is the surgical removal of the liver or of part of it. It is also called liver resection. The operation rests on a fact that is unusual in surgery: the liver regenerates. Provided the tissue left behind is healthy, as much as two-thirds can be removed and the remainder will grow back towards its original size.

Partial and total

A partial hepatectomy removes a section and leaves the rest. A total hepatectomy removes the whole liver and is therefore always part of a transplant — it is the first half of that operation rather than a procedure on its own. Living-donor liver transplantation is a partial hepatectomy performed on a healthy person, whose liver also regrows.

What it is done for

Primary liver cancer, hepatocellular carcinoma. Cancer that has spread to the liver from elsewhere, most often from the bowel. Benign tumours and other growths that are large, symptomatic or uncertain. Certain other liver diseases confined to one part of the organ. And donation, as above.

Why the anatomy makes it possible

The liver divides into two lobes — a larger right and a smaller left — and within them into smaller functional segments. Each segment has its own blood supply and its own bile drainage, so a segment can be taken out without cutting off the supply to its neighbours. That is what allows a surgeon to remove exactly what is diseased. The operation may be done open, through an incision across the upper abdomen, or laparoscopically through small ports; which is possible depends on the position and size of what is being removed, not on preference. It takes anywhere from about one hour to seven.

Recovery, and the regrowth

Hospital stay is around a week. Recovery at home takes roughly four to eight weeks after open surgery and two to four after a laparoscopic operation, with a return to full activity at about twelve weeks and six to eight weeks respectively. The remaining liver reaches close to its normal size in around three months. The figures assume the liver you started with was otherwise healthy — where there is cirrhosis, how much can safely be removed falls sharply, and that assessment is the main thing the surgical team is deciding before they agree to operate. Ask what proportion they intend to remove and what your liver function is expected to be afterwards.