Liver Resection Patient Information Booklet Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm
This booklet contains information about your operation. Please remember this booklet is not a substitute for asking questions of your doctor and specialist healthcare team. You are always welcome to ask questions and we would encourage you to do so. Introduction Your specialist has recommended that you have an operation called a liver resection. The reason for this operation is likely to be because your specialist believes there is a cancer that can be removed from part of your liver. We know that removing the cancer through an operation is the only way in which this cancer can be cured. Treatment with chemotherapy is not an alternative that offers a cure but may be helpful in slowing down and sometimes shrinking your cancer. Information about your cancer will be given to you in a separate booklet. The purpose of this booklet is to give you information about what to expect when you have a liver resection. The liver Your liver is a large organ found on the right-hand side of your body, under your ribcage. It has many vital functions, but you can live with only a part of your liver working. A few weeks after your operation, the part of your liver that was removed will grow back. Although the shape of your will be different, you will not notice any difference. The liver has a right and left side, also known as lobes. 2 PI_0172_04 Liver Resection
Right lobe Coronary ligament Left triangular ligament Left lobe Falciform ligament Ligamentum teres Gallbladder The part of your liver that gets removed or resected will depend on where the cancer is in your liver. For example, if your cancer is on the right side of the liver then you will have a right-sided liver resection. This is also known as a right hemi-hepatectomy. A cancer on the left side would require a left-sided liver resection or left hemi-hepatectomy. Your specialist believes that your cancer can be removed by resecting part of your liver. This decision is reached by looking at you and your scans and by consulting the radiologist (X-ray doctor) and other members of the team looking after you. Unfortunately sometimes during an operation it becomes clear to the surgeon that there is more cancer present than first thought. In these circumstances resection of the liver does not take place. We know from our own experience and evidence from other specialist centres that putting you through this big operation will have no benefit for you. You will return from the operation theatre and be nursed on the ward. Your recovery from this operation may be quicker than if you had undergone a resection. After we have seen you in clinic, you will be referred to an oncologist (cancer doctor) to PI_0172_04 Liver Resection 3
discuss other treatment such as chemotherapy. This may be different in patients with cholangiocarcinoma (bile duct cancer) who may undergo a bypass procedure. More information is given about this in the cholangiocarcinoma booklet. You can expect to stay in hospital 7-10 days after a liver resection, although everyone is different. Before the operation You will be seen in the prescreening clinic prior to your operation date. This is because we need time to ensure that we have all the information we need to make your operation as safe as possible. You will need to have a chest X-ray and a tracing of your heart (ECG). You will also need a blood test. You will then be asked to come into hospital on the day of your operation. Your surgeon will discuss your operation with you again and you will be asked to sign a copy of the consent form (this may have been done already in clinic). Your anaesthetist will also see you before your operation. The anaesthetist is the senior doctor who is responsible for you whilst you are asleep during your operation. Please use this time with your specialists to ask any questions you may have about your operation or anaesthetic. Please remember that if there is a liver transplant on the day of your planned operation then your surgery will be delayed. A delay may also occur if no critical care bed is available. We are very grateful for your understanding and patience. 4 PI_0172_04 Liver Resection
Potential complications A liver resection is a major operation and is only performed in a very specialist centre like the Liver Unit. Even in specialist centres such as ours, this operation has potential complications. The potential complications and the percentage of patients who are affected are listed below: Chest infection approximately 10% Wound infection approximately 5% Bleeding and a return to theatre for an operation approximately 1% Bile leak from the cut surface of the liver approximately 10% Liver failure (remaining liver cannot cope) 1% Some people experience jaundice, (yellowing of their skin and whites of their eyes) as a result of the liver working harder and having to cope after some of it has been removed. Jaundice in these circumstances is usually temporary, and goes when some new liver grows back. The shape of the cut used for this operation is horizontal, following the natural shape and curve below your rib cage. Because nerve endings are cut during the operation, this may leave you with some numbness around the scar site. People who have experienced this numbness do not usually report that it makes a difference to their lives. Unfortunately there are a small percentage (about 3%) of patients who will die as a result of their operation. These are very general percentages, and can change depending on the reason for your liver resection. More specific percentages will be found in the information booklet related to your cancer. PI_0172_04 Liver Resection 5
After the operation After you return from theatre you will be nursed in Critical Care for 1 or 2 nights depending on how stable you are. Although everyone is different, most people are awake but drowsy on the evening of their operation. After your operation you will be given some extra oxygen to breathe for a few days. This is given to you via an oxygen mask. Several lines or drips are put in place whilst you are asleep. The main line is the drip into the large vein in your neck. This line is removed about 4-5 days after your operation. You may also have a nasogastric tube put into place whilst you are asleep. A nasogastric tube goes down your nose and into your stomach. Its purpose is to help control any feelings of sickness you may have. A urinary catheter is also put in place whilst you are asleep this will drain your urine whilst you are not able to get up and about easily. It is removed about 4-5 days after your operation. A surgical drain is left in place in your abdomen after your operation. This is removed when the surgeon believes you are ready for it to come out; usually after 3-4 days. Although we cannot guarantee you will be pain free. We are confident we will be able to help control any pain you may have. Painkillers are usually given via an epidural line in your back. An epidural ensures a constant amount of painkillers where you need them. If this is not successful for you then there are other ways through which we can deliver your painkillers. 6 PI_0172_04 Liver Resection
Getting up and about There are potential complications from laying in bed for too long. Therefore, on the first day after your operation, we will help you to get out of bed and to sit in a chair for a short time. Your nurse and physiotherapist will help you practice deep breathing and coughing; this is important to prevent a chest infection. After 1-2 days you will be moved onto the main ward. As your lines are removed and you start to eat and drink, you will start to feel better. You will be close to going home. Going home Most patients are home within 5-7 days of this operation. Going home can be a very emotional time. You may be looking forward to it and dreading it in equal measure. These feelings are normal. A district nurse (also known as a community nurse) will visit you at home and you will have the ward and specialist nurse s contact numbers. You can call us if you have any questions or worries. It can take up to three months before you regain full fitness after a liver resection. You should only start to drive again when you feel you are able to perform an emergency stop comfortably and safely. Please do not feel as if you are cut off from the hospital team, we are on the end of a phone. You can speak to a surgical registrar by calling Ward 726 on 0121 371 7303. It is also a good idea to get the specialist cancer nurses in the community involved in your care. Macmillan Cancer Relief usually provide these specialist nurses. These nurses can offer PI_0172_04 Liver Resection 7
help and support in the community and can provide a good link between home and the hospital. Coming back to clinic You will be given an appointment to come back to see the surgeons when you leave the ward. Sometimes this is posted to your home address. If you have had not received an appointment within a week of going home, please ring the ward 0121 371 7303. When you come to clinic you will have an opportunity to ask questions, it may be a good idea to write these down beforehand. The results of any histology will be discussed with you. Histology is when the tissue removed during the operation is looked at under the microscope. The results of histology will usually confirm that the tumour removed was cancer. The clinics that see patients after their surgery are often very busy and you may have to wait for a short time. Please bear with us if you have to wait in the Outpatients department. Further information If you wish to have further information about your cancer or anything related to your illness, the following contact details may be helpful. The Patrick Room This is an information service based in the cancer centre at the Queen Elizabeth Hospital. The people here will be able to give you the contact details of an information service closer to where you live. Telephone: 0121 371 3539 8 PI_0172_04 Liver Resection
Useful websites www.cancerhelp.org.uk www.macmillan.org.uk Research into liver disease and liver cancer The Birmingham Liver Unit is one of Europe s leading centres for research into liver disease. A team of clini cal and laboratory scientists are working to better understand liver cirrhosis and liver cancer. In addition we have the expertise and facilities to develop and test new treatments. We are ideally suited to do this work in Birmingham because we have one of the largest liver transplant programmes in Europe, a large liver and pancreas surgery programme as well as a team of laboratory scientists with interna tionally renowned expertise in liver disease, hepatitis viruses and cancer. Our laboratories are supported by grants form various bodies including the Medical Research Council, Wellcome Trust, Cancer Research UK, the British Liver Trust and by kind donations to the Birmingham Liver Unit s Liver Foundation Trust. For more information about our research please visit: www.birmingham.ac.uk/liver www.uhb.nhs.uk/liver-surgery-research.htm After your operation, the diseased tissue that has been removed is taken to the laboratories and looked at to confirm the disease that you were diagnosed with. Sometimes small sections that are surplus to diagnosis requirements are taken for research. The doctors will ask for your permission to do this. Research may involve taking cells from your tissue sample and growing them for short periods to allow experiments on them in the labo ratory. Some of the cells or tissue may be frozen and stored for use in future experiments. When the research is completed the samples will be disposed of in an appropriate manner. PI_0172_04 Liver Resection 9
Please write down any questions you may have and bring this with you to your next appointment 10 PI_0172_04 Liver Resection
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The Trust provides free monthly health talks on a variety of medical conditions and treatments. For more information visit www.uhb.nhs.uk/health-talks.htm or call 0121 371 4957. Liver Services Queen Elizabeth Hospital Birmingham Mindelsohn Way, Edgbaston, Birmingham B15 2GW Ward 726: 0121 371 7303 CNS team: 0121 371 4652 PI15_0172_4 UHB/PI/0172 (Edition 4) Author: Catherine Markham and HPB CNS Team Date: May 2015 Review date: May 2017