Hepatectomy/Liver resection Surgery Cost in India

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What is Hepatectomy Surgery?

Hepatectomy is the surgical resection (removal of all or part) of the liver. While the term is often employed for the removal of the liver from a liver transplant donor.  A complete liver resection is performed in the setting of a transplant a diseased liver is removed from a deceased donor (cadaver).  A living donor may also provide a piece of liver tissue which is procured through a partial hepatectomy,  The procedure may be performed through a traditional open procedure or using minimally invasive techniques.

Why it is needed to be done?

Mostly hepatectomies are performed for the treatment of hepatic neoplasms, both benign or malignant. Benign neoplasms include hepatocellular adenoma, hepatic hemangioma and focal nodular hyperplasia. The most common malignant neoplasms (cancers) of the liver are metastases; those arising from colorectal cancer are among the most common, and the most amenable to surgical resection. The most common primary malignant tumour of the liver is the hepatocellular carcinoma. Hepatectomy may also be the procedure of choice to treat intrahepatic gallstones or parasitic cysts of the liver.

Functions of liver

Liver is a vital organ, meaning that one cannot live without it. The liver serves many critical functions including metabolism of drugs and toxins, removing degradation products of normal body metabolism (for example clearance of ammonia and bilirubin from the blood), and synthesis of many important proteins and enzymes (such as factors necessary for blood to clot). The liver, located in the right upper quadrant of the abdominal cavity, is divided into eightsegments reflecting the eight major divisions of the portal vein and the bile duct.   

Blood enters the liver from two channels, the hepatic artery and the portal vein, bringing nutrients and oxygen to liver cells, also known as hepatocytes, and bile ducts. The liver makes bile, a liquid that helps dissolve fat and eliminate metabolic waste and toxins via the intestine. Each hepatocyte creates bile and excretes it into microscopic channels that join to form bile ducts. Like tributaries joining to form a river, the bile ducts join to form a single "hepatic duct" that brings bile into the intestine.

Diagnosis/Preparation

A diagnosis of liver cancer requiring  hepatectomy is obtained with the following procedures:

• physical examination
• blood tests
• computed tomagraphy (CT) scan
• ultrasound test
• magnetic resonance imaging (MRI)
• angiograms
• biopsy

Surgery

The surgeon may remove a part of the liver that contains the tumor, an entire lobe, or an even larger portion of the liver. In a partial hepatectomy, the surgeon leaves a margin of healthy liver tissue to maintain the functions of the liver. For some patients, liver transplantationmay be indicated. In this case, the transplant surgeon performs a total hepatectomy, meaning that the patient's entire liver is removed, and it is replaced with a healthy liver from a donor. A liver transplant is an option only if the cancer has not spread outside the liver and only if a suitable donor liver can be found that matches the patient. While waiting for an adequate donor, the health care team monitors the patient's health while providing other therapy.

The surgical procedure is performed under general anesthesia and is quite lengthy, requiring three to four hours. The anesthetized patient is face-up and both arms are drawn away from the body. Surgeons often use a heating pad and wrappings around the arms and legs to reduce losses in body temperature during the surgery. The patient's abdomen is opened by an incision across the upper abdomen and a midline-extension incision up to the xiphoid (the cartilage located at the bottom middle of the rib cage). The main steps of a partial hepatectomy then proceed as follows:

• Freeing the liver. The first task of the surgeon is to free the liver by cutting the long fibers that wrap it.
• Removal of segments. Once the surgeon has freed the liver, the removal of segments can start. The surgeon must avoid rupturing important blood vessels to avoid a hemorrage. Two different techniques can be used. The first has the surgeon make a superficial burn with an electric lancet on the surface of the liver to mark the junction between the sections marked for removal and the rest of the liver. He/she cuts out the section, and then tears towards the hepatic parenchyma. It is the difference in resistance between the parenchyma and the vessels that allows the surgeon to identify the presence of a vessel. At this point, he/she isolates the vessel by removing the surrounding connective tissue, and then clamps it. The surgeon can then cut the vessel, without any danger to the patient. The second technique involves identifying the large vessels feeding the segments to be removed. The surgeon operates first at the level of the veins to free and then clamp the vessels required. Finally, the surgeon can make incisions without worrying about cutting little vessels.

After Surgery

The healing process takes time; the amount of time required to recover varies from patient to patient. Patients are often uncomfortable for the first few days following surgery and they are usually prescribed pain medication. The treating physician or nurse is available to discuss pain management. Patients usually feel very tired or weak for a while. Also, patients may have diarrhea and a feeling of fullness in the abdomen. The health care team closely monitors the patient for bleeding, infection, liver failure, or other problems requiring immediate medical attention.

After a total hepatectomy followed by a liver transplant, the patient usually stays in the hospital for several weeks. During that time, the health care team constantly monitors how well the patient is accepting the donated liver. The patient is prescribed drugs to prevent the body from rejecting the transplant, which may cause puffiness in the face, high blood pressure, or an increase in body hair.

Complications

• Bleeding
• Biliary fistula
• Atelectasis and pleural effusion
  
• Infection
  
• Liver failure

Frequently asked questions

Q.How long does liver resection surgery take?

Depending on the number and locations of the lesions, and how much liver needs to be removed, the procedure can take anywhere from one to seven hours.

Q. How successful is liver resection?

In most series, the overall 5-year survival rate reported following hepatic resection with curative intent ranges from 25%–37%, and with median survival of between 24 and 40 months.

Q. Is liver surgery serious?

Like partial hepatectomy, a liver transplant is a major operation with serious risks and should only be done by skilled and experienced surgeons. Possible risks include: Bleeding, infection, liver failure etc.

Q. Can you live with half a liver?

While you can't live without a liver completely, you can live with only part of one. Many people can function well with just under half of their liver. Your liver can also grow back to full size within a matter of months.

Q. How long do you stay in the hospital after liver surgery?

The length of time you're in the hospital after your surgery depends on the type of liver surgery you had and your recovery. Most people stay in the hospital for 5 to 7 days after having a liver resection.

Q. Can liver grow back after surgery?

The liver is the only solid internal organ capable of full regeneration. This means the remaining portion of your liver will grow back after surgery.

Q. How is a liver resection performed?

Liver resection is the surgical removal of part of the liver. Liver resections can be performed laparoscopically, using small incisions and a fiber optic camera, or in an open fashion, in which a large incision is made in the patient's abdomen.

Q. How long can you live with a failed liver?

Your recovery depends on the type of cirrhosis you have and if you stop drinking. Only 50% of people with severe alcoholic cirrhosis survive 2 years, and only 35% survive 5 years. Recovery rate worsens after the onset of complications (such as gastrointestinal bleeding, ascites, and encephalopathy).

Q. What food is good for liver repair?

Here are a few foods to include in your healthy liver diet:

• Coffee to lower abnormal liver enzymes.
• Greens to prevent fat buildup.
• Tofu to reduce fat buildup.
• Fish for inflammation and fat levels.
• Oatmeal for energy.
• Walnuts to improve the liver.
• Avocado to help protect the liver.

Q. Is liver resection safe?

Liver resection for benign liver disease is a safe procedure and leads to a significant improvement of quality of life in selected patients.

Q. What are the first signs of a bad liver?

If signs and symptoms of liver disease do occur, the may include:

• Skin and eyes that appear yellowish (jaundice)
• Abdominal pain and swelling.
• Swelling in the legs and ankles.
• Itchy skin.
• Dark urine color.
• Pale stool color.
• Chronic fatigue.
• Nausea or vomiting.

Q. How do I cleanse my liver?

1. Limit Alcohol. More than 90% of alcohol is metabolized in your liver.
2. Focus on Sleep.
3. Drink More Water.
4. Reduce Your Intake of Sugar and Processed Foods.
5. Eat Antioxidant-Rich Foods.
6. Eat Foods High in Prebiotics.
7. Decrease Your Salt Intake.
8. Get Active.