Hepatectomy (Liver Removal)
Partial hepatectomy is an operation to surgically remove part of the liver. Complete hepatectomy or the removal of the entire liver is only perform in liver transplantation, where the diseased liver is completely taken out so as to allow a new liver to be implanted.
In a healthy liver, up to three quarters of the liver can be removed safely. The left, right or central portion of the liver can be removed.
For patients with liver cancer, the operation aims to remove all the tumours in the liver, whilst leaving behind adequate remnant liver to ensure adequate liver function to sustain life.
The liver has eight segments, each segment of the liver has its own independent blood supply and bile drainage.
When the tumour is confined to the segment, the surgeon can remove each segment safely without affecting the function of the other segments. This operation is known as segmentectomy or segment oriented partial hepatectomy. Such an operation conserves more uninvolved liver tissue. Current imaging technology such as high resolution CT scan and intraoperative ultrasound provide high quality images for the liver surgeons to locate the tumour precisely and to analyse the relationship of the tumour to the neighbouring vital structures.
The liver is an organ with rich blood supply. It has dual blood supply, from the hepatic artery and the portal vein. Control of bleeding during surgery is therefore a major concern.
With improved operative techniques and advanced surgical technology such as Harmonic scalpel, ultrasonic dissector and argon plasma coagulator, the risk of bleeding during liver operations has dropped.
As liver surgery is a highly specialised and complex procedure, it should be performed by experienced Hepatobiliary surgeons.
Partial hepatectomy in patients with cirrhosis is challenging as these patients may not tolerate liver operations very well. After partial hepatectomy, liver failure due to poor liver regeneration is a major concern. Segmentectomy or segment oriented partial hepatectomy is a better choice for people with cirrhosis and small liver cancers. This technique is preferred to wedge resection of the liver because it is more anatomical.
Right Hepatectomy means the removal of segments 5,6,7 and 8
Left Hepatectomy means the removal of segments 2,3,4a and 4b
Central Hepatectomy means the removal of segments 4a, 4b, 5 and 8
Segments may also be removed individually. For example, monosegmentectomy 6 means the removal of just segment 6