Types of surgery for liver cancer

Surgery gives the best chance of curing primary liver cancer. There are different types of surgery for early liver cancer. These are:

• removal of part of the liver (liver resection or lobectomy)
• liver transplant

Who can have surgery for primary liver cancer?

Surgery might be an option for you if:

• the cancer is only in one part of your liver, and
• it has not spread to other parts of your body

You might have blood tests to see how well your liver is working. The liver is a very important organ. So the part of the liver left behind after surgery needs to work well enough to keep you healthy. Blood test results help your doctor decide if surgery is a suitable treatment for you.

If you have cirrhosis you might not have enough healthy liver for the body to cope with removing part of it. In this situation, you might have a liver transplant or other treatments. 

Liver resection and lobectomy

Removing the cancer and the surrounding tissues in your liver is called a resection. Your surgeon is only likely to consider a resection if:

• the cancer is small
• your liver is healthy
• the cancer hasn’t grown into the blood vessels

Your surgeon might remove a lobe of your liver. This is called a lobectomy or hemi hepatectomy. The liver can grow back and work normally if you don’t have any underlying problems, such as cirrhosis.

A type of liver cancer called fibrolamellar cancer is more likely to develop in people without liver disease. This means that surgery is often possible for these people.

Unfortunately there is a risk the cancer could come back after a liver resection. Sometimes cancer cells have broken away from the tumour before it is removed. That’s why this type of surgery is only used for small liver cancers as they are less likely to have spread.

A liver transplant

A liver transplant is an operation to remove your liver and replace it with a healthy liver from a donor.

A liver transplant is possible in some people with hepatocellular liver cancer. You might be able to have a liver transplant if you have:

• a single tumour no more than 5cm across
• a single tumour that is 5 to 7cm across and has not grown for at least 6 months
• no more than 5 small tumours, each no larger than 3cm across 

To have a liver transplant you need a donor liver that is a close match to yours. Unfortunately, you might have to wait a long time for a liver to become available and in this time the tumour might grow. Waiting for a liver transplant can be stressful for you and your family. Your doctor might consider other treatments in the meantime, such as ablation or chemoembolisation.

You might not be fit enough to have a transplant if you have very severe scarring of the liver (cirrhosis). A specialist transplant surgeon will look at all your test results and decide whether you are likely to make a good recovery from surgery. For example, they will look at the level of a chemical in your blood called alpha fetoprotein. If this level is too high, a transplant may not be suitable for you.