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Liver Surgery

Professor Peter Lodge is an internationally renowned hepatobiliary surgeon and has extensive experience in performing liver surgery. Patients from across the UK and overseas are regularly referred to Professor Peter Lodge as he undertakes complex liver  surgery and often takes on cases considered to be inoperable elsewhere.

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Questions About Liver Surgery

The liver is the largest organ in the body. The liver is a vital organ and it has a wide range of functions, including detoxification, protein synthesis, and production of biochemicals necessary for digestion. The liver plays a major role in metabolism and has a number of functions in the body, including glycogen storage, decomposition of red blood cells, plasma protein synthesis, hormone production, and detoxification. It produces bile, an alkaline compound which aids in digestion via the emulsification of lipids. The liver’s highly specialized tissues regulate a wide variety of high-volume biochemical reactions, including the synthesis and breakdown of small and complex molecules, many of which are necessary for normal vital functions. The liver lies just below the diaphragm, a muscle sheet that separates the lungs from the abdomen and helps us to breath.  It can usually be felt just below the ribs on the right hand side of the abdomen.

 

The liver can usually be felt just below the ribs on the right hand side of the abdomen

The liver is divided into eight different segments:

 

The liver is divided into eight different segments

The divisions are anatomical and are based on the blood supply and venous and bile drainage systems:

The divisions are anatomical and are based on the blood supply and venous and bile drainage systems

The divisions were worked out in the 1950s but not used as an aid to surgery until more recently. The divisions are helpful as they can determine the functional capacity of the liver following surgery to remove liver cancer and other tumours. After surgical resection of part of the liver, the remaining part grows to take over all the functions of the part that has been removed.  This is known as liver regeneration. Back to top

Unfortunately, primary liver cancer (heptocellular carcinoma and cholangiocarcinoma) is the sixth most common type of cancer and is the third most common cause of death from cancer worldwide. The 5-year survival rate without surgery is a disappointing 6.5%, but this figure has improved after major advancements in liver surgery to around 50%. The majority of liver cancer surgery in the West, however, is performed for secondary cancer, known as liver metastases and here again the results of successful surgery are excellent, and advancements in chemotherapy have also helped. Many experts think that only secondary liver tumours from colorectal cancer can be removed but in fact Professor Peter Lodge and others have shown that there are many other patients who can do well. For example, some patients with sarcoma (especially GIST), neuroendocrine (carcinoid), breast cancer, kidney cancer and some types of malignant melanoma can be helped by effective liver surgery. In addition, there are many benign (non-cancerous) liver conditions that can be helped by surgery. Examples include liver cysts, haemangioma, adenoma, and focal nodular hyperplasia.  However, liver surgery is not something anyone should rush into. There may be other more effective ways to sort out these problems and Professor Peter Lodge will be happy to advise you about this. Back to top

Although many types of cancer can be treated by chemotherapy (drugs to fight cancer) and radiotherapy (the use of x-rays to fight cancer), in most cases the only chance of cure is effective surgery to remove the primary cancer (where it has started) and any secondary cancers (where it has spread to). This can sometimes be done in a single operation, but is most often done as two separate surgical procedures. Often, surgery is combined with chemotherapy or other treatments to make the surgery more successful. An important decision is when to do the surgery and whether to add extra treatments such as chemotherapy before or after liver surgery.  Professor Peter Lodge will be able to advise you about this, as every case is different. In recent years, liver surgery has become one of the most successful wonders of modern medicine, with rapidly improving cure rates and new techniques. Many patients who in the past would have been considered to have inoperable disease can now be offered surgery. Back to top

Most liver surgery is done through a conventional abdominal incision, most often a cut from just below the breast bone to just above the navel and across to the right side below the ribs. This is because the liver sits beneath the ribcage, which protects it on a day-today basis, and good access is necessary to safely carry out this complex surgery. However, some liver operations can be done using minimal access techniques, known as laparoscopic (keyhole) surgery. The first stage involves carefully assessing the degree of liver involvement and a scan may be done during the surgery, in order to check the findings of the preoperative tests. Special surgical tools such as ultrasonic dissectors are used to cut through the liver, sealing blood vessels and bile ducts on the cut surface. Sometimes it is necessary to remove the bile duct and make a new one using a piece of intestine. This sounds complicated, and it is, but many of the techniques used today around the world have been developed by Professor Peter Lodge, so he will be happy to explain it to you Back to top

Liver surgery is usually quite complex and it can take anywhere between one and 12 hours in order to achieve the best possible results. The time it takes is not important – it is important that everything is done carefully to maximise the chance of cure and the safety of the procedure.  Expert anaesthetists work with Professor Peter Lodge to keep patients as safe as possible during the surgery. Back to top

It is rare these days for patients to undergo surgery without a reasonable chance of success. A full assessment using the most modern scanning techniques before surgery, such as CT, MRI and PET-CT scans, help to ensure that most patients undergo surgery with a good chance of cure or at least many extra years of healthy life. Cancer cure rates are improving every year.  Prof Lodge will discuss this with you and give you a clear indication based on exactly what is known at the current time about your case. Back to top

All surgery carries an element of risk and the degree depends on the scale of surgery required as well as age, fitness and other factors. Professor Peter Lodge will advise you about this when you see him.  These days, blood transfusion is rarely needed and with expert surgery, anaesthesia and aftercare the risks are reducing year on year.

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Yes, absolutely. In fact, a large part of Professor Peter Lodge’s work is dealing with patients from all around the UK and abroad who have been told that nothing can be done for them. Many of these patients are alive and well today after successful surgery with him. Usually, in order to save time and unnecessary anguish, Professor Peter Lodge will review your case based on medical notes and scans and then let you know if it is worth coming to Leeds for a visit. If notes and scans are not available, he will be happy to make arrangements for an initial scan and visit on the same day so he can then advise you about what is going on and what the chances are for the future.

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The first step with any medical condition is to talk to your family doctor. If you have been diagnosed as having a liver tumour then your local surgeon or oncologist may also be able to give valuable advice. You can ask him/her to refer you to Professor Peter Lodge at Spire Leeds Hospital for an opinion about whether liver surgery is the right choice for you or for a second opinion if you have been told that liver surgery is not possible. You can also get in touch directly if you would prefer. A typical appointment lasts about 30 minutes.

Click here to make an appointment.

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