The Liver
The liver is the largest organ in the body. It is a vital organ and 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 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.
Liver 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 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.
Liver cancer and other tumours
Unfortunately, primary liver cancer (heptocellular carcinoma and cholangiocarcinoma) are increasing worldwide. The 5-year survival rate without surgery is almost zero, 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 many patients with other secondary liver cancers can also do well. In addition, there are many benign (non-cancerous) liver conditions that can be helped by surgery. However, liver surgery is not something anyone should rush into. There may be other more effective ways to sort out these problems and Professor Lodge will be happy to advise you about this.
“My liver cancer was very advanced when it was eventually diagnosed. A liver specialist in Liverpool advised me that the tumour was too large and in a dangerous position to operate. He recommended that I see Professor Peter Lodge - The operation was a success, he managed to remove the tumour. The surgery has not so much changed my life – but given me life.”
How does surgery help?
Although many types of cancer can be treated by chemotherapy and radiotherapy, 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 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 before or after liver surgery. 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.
Liver Surgery - The operation
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. However, an increasing number of liver operations can be done using minimal access techniques, known as laparoscopic (keyhole) surgery.
Many of the techniques used today around the world have actually been developed by Professor Lodge, so he will be happy to explain it to you. Liver surgery 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.
What are the chances of success?
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. Professor 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.
“I had a large hepatocellular carcinoma (cancerous liver tumour) and without immediate surgery, I would have died, it is as simple as that. From the day I met Prof Lodge I just felt that if anyone could deal with the problem this was the guy to do it, and after the surgery he was equally fantastic.”
What are the Risks?
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 every year.
Can Professor Lodge look at my case if I have been told I am Inoperable elsewhere?
Yes, absolutely. In fact, a large part of Professor 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 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 usually on the same day so he can then advise you about what is going on and what the chances are for the future.
What is the First Step?
The first step with any medical condition is to talk to your family doctor (GP). 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 Leeds Nuffield Hospital or Spire Leeds Hospital for an opinion about whether liver surgery is the right choice for you. Don’t forget it is your right also to ask to be referred 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.