Management of Liver Tumors: Basic Surgical Methods

Management of Liver Tumors: Basic Surgical Methods

Liver tumors, with both their primary and metastatic types, hold a significant place in the medical world. The most common among primary liver cancers is hepatocellular carcinoma (HCC). Metastatic liver tumors, on the other hand, typically originate from colon, rectum, breast, or lung cancers. Surgery is generally considered the most effective treatment option for the management of liver tumors. This article will discuss the basic surgical methods used for liver tumors in detail.

General Principles of Liver Surgery

Liver surgery requires a deep understanding of anatomy and physiology. The liver is an organ with a dual blood supply (portal vein and hepatic artery) and a high capacity for regeneration. However, surgical interventions must take these characteristics into account. Surgeons aim to remove the cancerous tissue while preserving healthy liver function.

Criteria for Surgical Candidacy:

• The size and location of the tumor.

• The remaining volume and functional capacity of the liver.

• Metastatic status.

• The patient's general health and comorbidities.

Basic Methods Used in Liver Surgery

1. Hepatectomy

Hepatectomy refers to the surgical removal of a lobe or segment of the liver.

• Right Lobectomy: The removal of the liver's right lobe. It is generally performed for larger tumors.

• Left Lobectomy: The removal of the liver's left lobe. It is considered a less invasive procedure.

• Segmentectomy: The removal of a specific segment of the liver. This method is preferred for small and localized tumors.

Advantages:

• Offers the possibility of a radical cure.

• Optimizes remaining functional capacity by preserving healthy liver tissue.

Disadvantages:

• Can be a technically challenging procedure.

• Carries a risk of postoperative complications.

2. Laparoscopic Liver Resection

Laparoscopic surgery is a minimally invasive method that is increasingly preferred for removing liver tumors. It is performed through small incisions using special instruments and a camera.

Advantages:

• Less postoperative pain.

• Faster recovery process.

• Shorter hospital stay.

Disadvantages:

• Technical challenges and a long learning curve.

• Limited application for large tumors.

3. Robotic Surgery

Robotic surgery offers the advantages of the laparoscopic method while providing the surgeon with greater precision and dexterity. Robotic systems offer a significant advantage, especially in accessing difficult anatomical areas.

4. Transplantation (Liver Transplant)

Liver transplantation involves completely removing the diseased liver and replacing it with a healthy donor liver. It is applied especially in cases of hepatocellular carcinoma with co-existing conditions like alcoholic cirrhosis.

Suitability Criteria:

• Meeting criteria like the Milan criteria (based on tumor size and number).

• Availability of a suitable donor.

• Control of co-existing illnesses.

5. Combined Surgery with Ablation Techniques

Surgical methods can be combined with techniques such as radiofrequency ablation (RFA) or microwave ablation (MWA). This combination can be an effective option for patients who are not candidates for resection or are borderline surgical candidates.

Risks and Complications of Surgical Methods

Despite offering many advantages, liver surgery is associated with risks and complications:

• Bleeding: The risk of bleeding is high due to the liver's vascular structure.

• Infection: There is a risk of infection after the surgery.

• Liver Failure: Can develop if a sufficient amount of functional liver tissue cannot be preserved.

• Bile Leakage: Can occur due to potential damage to the bile ducts during surgery.

Technological Developments and Liver Surgery

In recent years, advancements in surgical techniques have increased the effectiveness of liver surgery:

• Intraoperative Imaging: Helps surgeons to see the tumor more clearly.

• 3D Printing Technology: Allows for the creation of individual liver models for pre-operative planning.

• Artificial Intelligence and Robotic Systems: Enables more precise surgical interventions.

Post-Surgical Patient Management

The post-surgical recovery process is a crucial part of the surgery's success. Points to consider during this period include:

1. Nutrition:

   • Sufficient protein and energy intake should be ensured.

   • A balanced diet is recommended to support liver function.

2. Post-operative Monitoring:

   • The function of the remaining liver is evaluated with regular blood tests and imaging methods.

3. Complication Management:

   • Complications such as bleeding, infection, and liver failure should be identified and treated early.

Conclusion

Surgery for liver tumors plays a significant role in improving patients' long-term survival. Methods like hepatectomy, laparoscopic surgery, robotic surgery, and liver transplantation can be customized for different disease states. The success of surgical treatment is directly related to appropriate patient selection, the correct application of surgical techniques, and post-operative care. Thanks to technological innovations and multidisciplinary approaches, liver surgery will become even more effective and safer in the future.