Surgery for Liver Metastases - Medical Experts

A metastasis is a tumor that forms when cancer cells from the primary tumor spread to a distant part of the body. This is referred to as a secondary tumor, while the original tumor is called the primary tumor.

Metastases can develop in the liver as a result of various types of cancer. During surgery, the surgeon attempts to remove these metastases.

Most patients with liver metastases have a primary tumor

• in the colon,
• the esophagus,
• in the lung, or
• the breast.

With smaller metastases, the liver still functions normally. The more healthy tissue is destroyed by the tumors, the greater the risk of organ failure. Surgery is therefore particularly beneficial in the early stages of metastasis.

Since liver surgery is a complex procedure, its benefits are carefully weighed. Here, oncologists—specialists in cancer—work hand in hand with experts from other medical fields. These include, for example, general and visceral surgeons.

Surgery for liver metastases must be carefully planned. During the preparation phase, surgeons must precisely determine which tissue needs to be removed. Under no circumstances should they remove too much tissue during the procedure. Otherwise, the liver will no longer be able to adequately supply the body after surgery.

To identify potential risks in advance, doctors also perform blood tests and liver function tests.

If the patient’s liver is not large enough for immediate surgery, portal vein ligation or portal vein embolization may be performed. In this procedure, the blood supply to certain areas of the liver is temporarily interrupted. The remaining parts of the liver then grow to compensate for the loss of tissue.

This allows doctors to increase the size of the healthy portions of the liver even before the surgical procedure.

The exact course of the surgery depends primarily on

• the number,
• the location, and
• the size

of the metastases. The surgery is usually performed through an incision in the abdomen. In some cases, a minimally invasive procedure is also possible. In this case, the surgeon makes only a very small incision and performs the surgery using a camera and various specialized instruments.

Depending on the location of the metastases, parts of the liver are then removed. This is also referred to as a right-sided or left-sided liver resection.

After liver surgery, the patient is cared for in the hospital’s intensive care unit for a few days and given pain medication.

The liver is an organ that can regenerate very well. When part of the liver is removed, the organ grows so that the new tissue can take over the functions of the removed sections.

It takes several weeks for the liver to become fully functional again. During this time, it must be ensured that liver function can adequately support the patient’s body.

One complication of liver metastasis surgery is the development of bile fistulas, in which bile leaks from the surgical site. Bleeding or infections may also occur in rare cases.

Patients are typically discharged from the hospital 8 to 10 days after liver metastasis surgery.

Immediately after surgery, they receive pain medication to help them get back on their feet as quickly as possible. As a result, most patients are able to get out of bed and eat as early as the day after liver metastasis surgery. Nevertheless, the procedure on the liver should not be underestimated. Lifting heavy objects is prohibited for several months.

After surgery, liver function is initially limited. Therefore, patients should take it easy on their liver as much as possible following surgery for liver metastases. They should definitely avoid alcohol.

The use of medications that put a strain on the liver should also be strictly limited. Patients should therefore always consult their treating physician before taking any medications.

If the surgeon is able to completely remove the metastases during liver metastasis surgery, the prognosis is good.

However, it also always depends on how advanced the primary tumor is. If the surgery is successful and there is still sufficient liver tissue remaining to support the body, the survival rate for colorectal cancer patients with liver metastases is around 50 percent.

Surgery is not the only treatment option for liver metastases. So-called systemic treatments act not only locally on the liver but throughout the entire body. These treatments include chemotherapy. In this case, patients receive medications (cytostatic drugs) designed to stop or slow the growth of tumor cells.

Another local treatment for liver metastases is radiation therapy. In this procedure, cancer cells are destroyed using particle or ionizing radiation. Radiation therapy may also be beneficial prior to surgery for liver metastases to initially reduce the size of very large metastases.

Surgery for liver metastases is primarily performed for small and isolated metastases in the liver. It can be used as a standalone treatment or to complement other cancer treatments.