About the liver

The liver is a vital organ that filters toxins from the body, cleanses and detoxifies, secretes bile, and produces essential building blocks for healthy bodily function. The liver also plays a key role in the body's metabolism

Liver surgery in Israel

In Assuta’s liver surgery service, top Israeli surgeons perform both basic and complex procedures using leading technologies. These assets, along with world-class knowledge and techniques make the Assuta Liver Surgery Department an international center of excellence.

Liver (hepatic) cancer and treatment

Patients diagnosed with liver cancer typically require surgery to remove malignant or benign tumors. Surgery is currently the only treatment option for long-term survival in patients with liver metastases, including bowel and rectal cancer and primary tumors of the liver.

Surgical treatment of liver metastases from colon cancer

The field of medicine has seen far-reaching developments in preoperative therapies, surgical techniques, and systemic chemotherapy to treat liver metastases from colon cancer. These new treatment options have demonstrated significant increases in median survival and five-year survival rates in patients with liver metastases.

Liver resection surgery

When surgeons describe "liver resection," it means surgery to remove part of the liver – the diseased part and small margins around the disease. Complete liver resection is only performed for an immediate liver transplant.

Parts of the liver can be removed because liver cells regrow (regenerate). The extent of the surgery a patient needs is determined primarily by the size and number of lesions to be removed. However, in some cases, a limiting factor in treatment is the volume of liver that remains functioning and necessary to preserve bodily function.

When is liver resection surgery required?

A patient may require a liver resection when he or she has benign or malignant liver lesions – or tumors that have spread (metastasized) from other organs to the liver. In rare cases, when a patient has a tumor in a nearby organ such as the gallbladder or bile ducts, liver resection surgery will be necessary.
The guiding principle in liver surgery is to completely remove the tumor while leaving enough residual liver tissue that the liver can function (parenchymal sparing).

Surgery in benign conditions

For certain benign tumors, liver resection does not need to be extensive. This procedure, in which the surgeon cuts the lesions and small margins around them, is called enucleation.

Liver resections for malignant diseases

The guiding principle for removing malignant liver tissue is to remove the lesions along with a small margin of healthy tissue around the lesions, to ensure that no tumor cells remain. It is essential that enough liver tissue remain to support liver function (parenchymal sparing). Very thin margins can be used if chemotherapy is added to the patient’s treatment plan.

Anatomical resections of the liver in malignant diseases

Anatomical resection surgeries take into account the blood supply and drainage of the liver according to the structure of the liver’s 8 lobes.

Treatment methods when insufficient liver tissue remains

The pre-condition required for a patient to undergo surgery is to have a future liver remnant (FLR), a disease-free area of the liver that will continue to function following surgery.

When cancer is diagnosed and a patient does not have a sufficient a future liver remnant, physicians can use several methods to improve the situation, including:

• Portal vein embolization (PVE)
• Systemic chemotherapy
• Two-stage liver resection (two-stage hepatectomy)
• Associating liver partition with portal vein ligation (PVL) for staged hepatectomy (ALPPS)/in situ splitting
  
  

Portal vein embolization

For patients with projected borderline reserves, a portal vein embolism (PVE) is used to create controlled liver tissue growth/regeneration (hypertrophy) from the liver remnant. This procedure is part of the standard pre-surgery protocol to help prevent post-operative liver failure.

Systemic chemotherapy

For patients with inoperable liver cancer, systemic chemotherapy is still the accepted first-line treatment.

In cancer patients with liver metastases from colorectal cancer, chemotherapy may reduce the tumor to the point where surgery can then be performed.

Two-stage liver surgery (hepatectomy)

Two-stage liver surgery may help patients with inoperable cancer undergo a complete resection in phases. Compared to patients who receive chemotherapy alone, patients who undergo a hepatectomy have improved survival rates.

In this two-phase treatment, the patient first undergoes 4-6 rounds of systemic chemotherapy. If the patient’s tumor responds well to the chemo or the disease has stabilized, he/she then undergoes the first stage of resection. During this phase, the metastases are usually removed from the future liver remnant. Time is allocated for the remnant to partially regenerate. The second surgery is then performed to remove remaining cancerous tissue.

Tumor destruction methods

RFA: radiofrequency ablation

Radiofrequency ablation is the most common technique to remove cancerous liver tissue. Guided by medical imaging, the physician inserts an electrode into the tumor, and using thermal (heat) energy, destroys the tumor and some of the healthy tissue surrounding it.

Microwave ablation

This technology directs high heat to a large area of the liver. Guided by ultrasound or CT imaging, the physician inserts an electrode into the tumor. The electrode transmits microwave energy to the tumor, which destroys it.

Cryoablation

This method uses extreme cold to destroy tumor cells. Under ultrasound, the physician injects freezing cold liquid nitrogen or argon gas into the tumor. This creates ice crystals that damage the cell structure, killing the tumor cells and surrounding cells.
Due to high cancer recurrence and complication rates, this method is not used very often. The most dangerous complication from this procedure is cryo-shock (shock from extreme cold), which may cause potentially deadly hypothermia, bleeding disorders, respiratory failure, or kidney failure.