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Liver Resection (Hepatectomy)

Surgical Removal of Liver Segments for Tumors and Benign Lesions

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Liver Resection (Hepatectomy)?

Liver resection is the en-bloc removal of segments, sectors, or one or more lobes of the liver, with intent to cure malignancy, eradicate benign disease, or remove a damaged segment.

Anatomic resections follow Couinaud's segmental anatomy (hemihepatectomy, sectoriectomy, segmentectomy); non-anatomic wedge resections target focal lesions while preserving liver volume.

Approaches include open surgery (subcostal or J-shape incision), laparoscopic, and robotic — minimally invasive techniques are increasingly used for left lateral and right posterior sectors.

Adequate future liver remnant (≥25% in healthy liver, ≥40% in cirrhotic or post-chemotherapy liver) is essential to prevent post-hepatectomy liver failure.

Symptoms

Pre-operative findings: hepatic mass on imaging, elevated tumor markers (AFP, CEA, CA 19-9), or symptoms of mass effect
Hepatocellular carcinoma symptoms: right upper quadrant pain, weight loss, decompensation in cirrhotic patients
Colorectal liver metastases: typically asymptomatic and detected on surveillance imaging
Postoperative concerns: bile leak, post-hepatectomy liver failure, hemorrhage, intra-abdominal abscess, pleural effusion, ascites
Functional consequences: transient coagulopathy, hyperbilirubinemia, encephalopathy in major resections

Risk Factors

Hepatocellular carcinoma in non-cirrhotic or compensated cirrhotic liver
Colorectal liver metastases — synchronous or metachronous, with intent of curative R0 resection
Cholangiocarcinoma (intrahepatic, hilar) requiring formal hepatectomy with biliary reconstruction
Neuroendocrine tumor liver metastases for symptom and tumor burden control
Symptomatic or large benign lesions: focal nodular hyperplasia, hepatic adenoma >5 cm, giant hemangiomas
Hydatid disease, hepatolithiasis, polycystic liver disease, and selected hepatic trauma

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Newly detected liver mass on imaging requires multidisciplinary evaluation
  • Cirrhotic patient with elevated AFP or imaging findings suspicious for HCC
  • Colorectal cancer patient with new liver lesions on surveillance imaging
  • Right upper quadrant pain or palpable mass in patients with chronic liver disease
  • Postoperative fever, jaundice, persistent drain output, or abdominal distension

Treatment Methods

01
Pre-operative assessment: high-quality contrast-enhanced CT or MRI with hepatocyte-specific contrast, volumetric analysis of future liver remnant, ICG retention test, and Child-Pugh/MELD score in cirrhotics
02
Pre-operative portal vein embolization or staged hepatectomy (ALPPS, Two-stage) when future liver remnant volume is inadequate
03
Surgical principles: low central venous pressure anesthesia, intraoperative ultrasound for tumor localization, parenchymal transection with CUSA or ultrasonic shears, Pringle maneuver for vascular control
04
Minimally invasive resection (laparoscopic or robotic) for selected segments with reduced blood loss and faster recovery
05
Enhanced recovery after surgery (ERAS) protocols: early mobilization, early oral intake, multimodal analgesia
06
Postoperative monitoring: liver function tests, coagulation, lactate, and 50-50 criteria for liver failure (bilirubin >50 μmol/L and PT <50% on day 5)
07
Adjuvant therapy depends on indication: chemotherapy for colorectal metastases, sorafenib/lenvatinib in HCC with high recurrence risk in clinical trials, somatostatin analogs for NET
08
Long-term surveillance: imaging every 3–6 months for 2 years then every 6–12 months; tumor markers; transition to transplant evaluation if recurrence in cirrhotic HCC

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.