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 chosen based on the patient's condition and the physician's judgment.
The objectives include directly removing malignant tumors to prolong patient survival or removing benign tumors (such as hepatic adenomas) that hinder liver function. Advances in minimally invasive techniques in recent years have significantly improved surgical trauma and recovery time, making it the preferred treatment for malignant liver tumors.
Liver resection mainly divides into anatomical resection (segmental removal based on hepatic blood vessels and bile ducts) and non-anatomical resection (direct removal of tissue surrounding the tumor). Minimally invasive surgeries such as laparoscopic or robot-assisted liver resection use small incisions to insert endoscopic instruments, reducing tissue damage and speeding up recovery.
The mechanism involves complete removal of diseased tissue while preserving enough healthy liver tissue to maintain metabolic functions. The remaining liver tissue will regenerate after resection, but it is necessary to evaluate whether the patient's liver function is sufficient to support regeneration, to avoid the risk of liver failure.
Applicable to primary liver cancers (such as hepatocellular carcinoma), metastatic liver cancers, large benign tumors (such as hepatic hemangiomas), or cases with recurrent infections caused by intrahepatic bile duct stones. When tumors have not metastasized and the patient's liver function meets Child-Pugh grade B or below, surgery is considered appropriate.
Other situations include liver cysts compressing vital structures, extensive trauma causing large-area damage, or certain hereditary liver diseases (such as hepatic adenomas). Tumor margins must be confirmed through imaging and pathological examination to ensure complete resection is feasible.
The surgery requires general anesthesia and is divided 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 a 10-20 cm abdominal incision.
There is no concept of "dosage," but the resection scope must be precisely calculated. Surgeons use preoperative 3D imaging simulation to ensure the 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 liver and avoids the use of immunosuppressants. For early-stage liver cancer patients, the low rate of local recurrence post-surgery makes it a key curative option.
Main risks include heavy bleeding, liver failure, and bile leakage. Postoperative complications may include abdominal infection, thrombosis, or coagulation abnormalities caused by liver tissue injury. About 5-10% of patients may experience residual liver dysfunction syndrome, leading to acute liver failure.
Short-term side effects include pain, diarrhea, or nutrient absorption disorders. Long-term effects may impact coagulation function or cause metabolic abnormalities. Elderly patients or those with pre-existing poor liver function are at higher risk of complications and require close monitoring.
Contraindications include Child-Pugh C liver function, extensive metastatic tumors, uncontrolled coagulation abnormalities, or systemic failure unable to tolerate anesthesia. Preoperative assessment of cardiac and pulmonary function, as well as the relationship between tumors 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 medication adjustments to prevent intraoperative bleeding.
When combined with liver transplantation, tumor characteristics must meet Milan criteria. When used with radiotherapy, attention should be paid to the additive effects of radiation-induced liver damage and surgical trauma.
Early-stage hepatocellular carcinoma patients undergoing liver resection have 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; with moderate resection, the remaining liver can restore function 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 do not replace the curative effect of surgery. Choice of alternatives should consider tumor staging and overall patient health.
What preparations are needed 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 necessary to reduce surgical risks.
What are the postoperative pain management methods after liver resection?
Initially, patients may use patient-controlled analgesia (PCA) pumps to control pain, transitioning to oral pain medications later. Physical therapy-guided deep breathing exercises are also recommended to relieve chest pain and prevent pulmonary complications. Patients should avoid breath-holding or vigorous activities to reduce abdominal tension.
How should diet be adjusted postoperatively to promote recovery?
The first week post-surgery should focus on liquid or semi-solid foods, such as rice porridge or steamed fish congee, eaten in small frequent meals. Gradually, high-protein foods (like quality fish and soy products) are introduced over 2-4 weeks to aid tissue repair, while high-fat and fried foods should be avoided to reduce liver metabolic burden. Regular monitoring of liver function is necessary to adjust dietary plans.
How is the risk of recurrence after liver resection assessed and monitored?
Physicians will develop follow-up plans based on the nature of the primary disease (malignant or benign cysts). Typically, ultrasound or tumor marker blood tests are performed every 3-6 months postoperatively, with more frequent monitoring in the first two years. Patients with a history of cirrhosis require closer surveillance of portal pressure and liver function abnormalities.
How long after surgery can patients resume daily activities? When can exercise be resumed?
Generally, 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 a 3-6 month waiting period, with gradual increase in intensity based on liver function recovery assessed by rehabilitation specialists.
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