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The term hepatectomy has two meanings. First, it refers to the complete removal of the liver, which is carried out in preparation for a liver transplant to treat complete liver failure. The second meaning applies to the removal of part of the liver; this procedure is also called a partial hepatic resection. Partial hepatectomy is usually carried out as a treatment for benign or malignant liver tumors, or gallstones located in the liver.
When cancer is located in the liver and can be removed via surgery, it is known as a localized resectable liver cancer. To be considered both localized and resectable, the cancer must be located entirely in the liver, and cannot have metastasized to other parts of the body. Surgery may be performed even if the cancer is not resectable; in such cases the liver tumors are usually metastases from other locations.
The nature of the procedure depends largely on how many tumors are located in the liver, where they are located, and how large they are. Another issue is whether the liver is still functioning at or near normal levels. All of these factors help determine how much of the liver will be removed during the surgery.
In most cases the objective is to remove as little tissue as possible while still ensuring that all of the cancer has been excised. Complete removal of the liver is carried out only when there is no other option for removing the cancer, or when liver function fails entirely. In either case, a suitable donor organ must be located before the non-functional liver can be removed.
A hepatectomy takes up to four hours to perform, and is carried out with the patient lying face up, under general anesthetic. The surgery begins with an incision in the abdomen. Next, the surgeon must cut through connective tissue so that the liver can be moved and examined freely.
Once this has been achieved, the surgeon can begin to remove diseased portions of the liver. This is difficult because several large blood vessels supply the liver with oxygen; if one is ruptured a major hemorrhage may result. To prevent these types of problems large vessels are usually clamped before the surgeon begins to work near them. With vessels safely clamped, the surgeon can proceed to remove diseased sections of the liver. Once this phase of the procedure is complete the incision is closed.
Patients usually require hospital care for approximately two weeks; following a liver transplant, this may be extended to a month or longer. Partly due to its much faster recovery time, laparoscopic hepatectomy has become a favored method of performing this surgery. Laparoscopy involves the insertion of a tiny lighted camera into the abdomen, allowing a surgeon to operate without having to open up the entire abdomen. This type of surgery is less invasive and has a faster recovery time, as it can be carried out through a much smaller incision.
Hepatectomies have several associated risks. The most problematic of these is post-surgical bleeding; if this occurs, the patient must often be rushed back into surgery so that the bleeding can be controlled. One of the most common risks is that of pulmonary complications such as pleural effusion, in which fluid builds up in the lungs. Such side effects are not dangerous as long as the patient has no pulmonary disease. If patients have an underlying liver disorder they are at risk of liver failure following the surgery. Typically people who are at increased risk of serious complications will require a longer stay in hospital after the hepatectomy is over.