Surgery for metastatic liver cancer
(secondary liver cancer)
What are liver metastases (secondary liver cancer tumours)?
Cancer cells over time break away from their (primary) cancer site, and then spread and deposit themselves in the liver via the blood stream. This is known as secondary liver cancer or metastases. The primary cancer is located in another area of the body (most commonly – colon, rectum, other sites include - breast, stomach, oesophagus lung and skin). If undetected or untreated the primary and secondary cancers grow in an uncontrolled fashion over time.
Over 50% pf people with Colo-rectal cancer (cancer affecting the colon or rectum) will go on to develop liver metastases.
Surgery to remove colorectal liver metastases is established effective treatment in select patients. Occasionally surgery can be carried out to remove the bowel cancer and liver metastases in the same operation (synchronous surgery).
Who is suitable for metastatic liver cancer surgery?
Liver surgery is possible in those who can withstand major surgery (physiological reserve). Surgery to remove liver metastases (most frequently from bowel cancer) is feasible based on number, distribution and location of these metastases with acceptable amount of disease free functional liver remnant (approximately 25-30% good functioning liver, dependent on body weight).
Cases need to be accurately assessed pre-operatively. Careful clinical assessment along side tumour biology and radiology often with CT, MRI and or PET scans is undertaken before proceeding with liver surgery.
Liver surgery is not possible for everyone, and not all types of metastasised cancer can be surgically treated either. Surgery isn’t likely to be offered if your cancer has spread to other parts of the body (multiple sites in lungs, bone or peritoneum) or if there are far too many, deposits in the liver without adequately spared, disease free liver.
The kind of treatment you’ve already had, general health and symptoms one experiences are vitally important and need to be considered.
What happens during liver surgery for metastatic colorectal cancer?
The aim of the liver surgery is to cure and completely remove the metastases or part of the liver (known as hepatic resection). These can be undertaken as most often as open surgery and in select cases using minimally invasive techniques (laparoscopic or robotic).
Preoperative contrast enhanced CT, MRI and PET scans are used to assess the extent of the liver metastases and to ensure there is no spread to other areas of the body.
At the time of surgery the size, number of the metastases, as well as their location relative to blood vessels within the liver is assessed using intra-operative ultrasound. It’s vital to determine that enough liver tissue with adequate blood flow and bile drainage is left behind after the cancerous tissue is removed to avoid liver failure post operatively.
The diseased liver with metastases is removed with wide margin to prevent recurrence. The resected sites are checked to ensure no bleeding and leakage of bile occurs, as these remain complications of liver surgery.
laparosopic liver resection
The liver has an amazing capability to regenerate hence there is increase in size and remodelling that occurs after liver resection. Depending on the distribution of liver metastasis and occasionally pre-operatively in the event the remnant liver volume is inadequate your surgeon might recommend that a two-stage operation takes place.
Removing small part of the cancer on one side of the liver first, and blocking the blood supply to the other side allows for the healthy part of the liver to “grow”. This is to ensure there will be enough good liver to cope after the resection of the cancerous parts of the liver. The growth is encouraged by a procedure to block the right or left branch of the hepatic portal vein, which is the main vein leading to the liver from the gut then a second major operation is undertaken to remove the disease liver a week or so later
Chemotherapy may be recommended before and / or after liver surgery.
Liver surgery for metastatic colorectal cancer is major surgery. You will stay in hospital for several days depending the kind of liver resection done, spending around 24 hours in the intensive care unit before returning to a ward. Getting back to normal may take several months.
How successful is liver surgery for metastatic colorectal cancer?
Patients who live for 10 years after their liver resection surgery can consider themselves cured of their cancer, and this may happen for one in six patients. Overall, the number of patients alive five years after their liver resection surgery for colorectal metastases is around 40-58%.
Mr Deepak Hariharan, is a leading Consultant Consultant General and Hepato-Pancreato-Biliary (HPB) Surgeon, with expertise liver surgery for metastatic colo-rectal cancer.
If you would like to book a consultation with Mr Hariharan, please contact the LIPS team at: