Hepatectomy

The liver is a large, vital body organ present in the upper abdominal region, more towards the right side. The liver is divided into segments, called lobes, that act like a filter for blood. A segment of the liver can be safely removed without affecting the other parts of the liver.
The liver has the property of regeneration. The healthy liver can grow back to its former size if the remaining portion of your liver is healthy after the removal of the diseased liver.

Types:
Hepatectomy is of the following different types:

1. Complete or total hepatectomy: This procedure involves the removal of the entire liver, which needs to be followed by liver transplantation.
2. Partial hepatectomy: This procedure involves the removal of only a part of the liver. The cells of the remaining part of the healthy liver will then multiply to replace the cut part.

Symptoms

A hepatectomy is recommended in the following cases:

• Liver cancer, known as hepatocellular carcinoma
• Cancers that spread to the liver from the colon (large intestine)
• Carcinoid tumor (a slow-growing tumor that can arise in many different places throughout the body)
• Benign (non-cancerous) liver tumors 
• Hepatolithiasis (bile stones in the liver)
• Hydatid cyst disease (parasitic fluid-filled swellings in the liver)
• Large liver hemangiomas (abnormal growths containing blood vessels)
• Acute or chronic liver failure
• Congenital diseases affecting the liver
• Partial hepatectomy for liver donation 

Diagnosis

1. Physical examination: The doctor will evaluate the overall physical health of the patient. The symptoms and medical history of the patient are also evaluated.
2. Complete blood count (CBC): The various blood parameters can be checked by the doctor with the help of CBC.
3. Kidney function tests: These tests help in checking how well the kidneys are working.
4. Alpha-Fetoprotein blood (AFB) test: AFB is a type of protein that is used as a marker for liver cancers and some other types of tumors. It can also act as a marker for patients on a follow-up basis, and if the AFB levels increase again after treatment, it may indicate the return of the disease.
5. Liver function tests: These tests help in checking the status of the liver function.
6. Blood clotting tests: The liver aids in stopping bleeding by producing some proteins that help in blood clotting. A damaged liver will not make enough of the clotting factors, which leads to an increased risk of bleeding. These tests are known as prothrombin time and partial prothrombin time.
7. Ultrasound: This test is done to determine the extent of the disease and liver damage.
8. MRI scans: These tests help to differentiate between benign (non-cancerous) and malignant (cancerous) tumors.
9. PET scans: A three-dimensional image of the liver or pancreas, along with their surrounding structures and organs can be obtained using these scans. These scans can also be used in conjunction with CT scans.
10. Biopsy: The doctor may surgically excise the suspected liver tissue growth and send it to the laboratory for evaluation.
11. Angiography: This test helps to assess the structure of the different blood vessels of an organ. It gives the doctor an idea about the extent of the tumor and helps in planning the surgery accordingly.
12. Radionuclide scan: It consists of the following two types of scans:
13. Bone scan: This type of scan is recommended in cases where the doctor suspects that cancer has spread to the bones.
14. Radio-labelled meta-iodobenzyl guanidine (MIBG): This test helps in visualizing certain types of cancers such as liver neuroblastoma and carcinoid tumors. 

 

Treatment

The procedure will vary depending on the part of the liver being removed and the surgical technique being used. Hepatectomy is usually performed using the following steps:

1. The procedure is generally performed under general anesthesia, which means that the patient will be put to sleep during the procedure.
2. The surgeon then makes incisions or cuts, which will vary depending on the technique being used for the surgery. The different surgical techniques that can be used include:
3. Open surgery: It involves making a long incision across the abdomen to open the abdominal cavity.
4. Laparoscopic surgery: It involves making four to six keyhole incisions and putting a laparoscope (a tube with a camera on one end) and other surgical instruments inside the keyhole incisions to perform the procedure.
5. Robotic surgery: It is a laparoscopic surgery performed by robotic arms that are controlled by the surgeon by looking at the computer monitor that is attached to the camera of the laparoscope. This technique offers better precision and helps in easy maneuvering during the procedure.
6. The surgeon will then identify the section of the liver that needs to be removed. An intra-operative ultrasound may be helpful in mapping the liver.
7. The liver tissue is then dissected after isolating the bile ducts and blood vessels and controlling them using staplers or metallic clips.
8. Ultrasonic energy devices, electro-cautery devices, or a laser may be used to dissect the liver and control the bleeding.
9. In case of laparoscopic or robotic surgery, the surgeon may need to make an additional two-to-five-inch incision to remove the resected liver from the body.
10. The surgeon will then close the incisions using sutures.
11. The entire procedure may take two to six hours to complete, depending on the extent of liver resection performed.

Risks

Hepatectomy may be associated with the following complications:

• Bleeding
• Infection
• Pneumonia
• Bile leakage
• Pleural effusion (buildup of fluid inside the chest cage)
• Ascites (buildup of fluid in the abdominal cavity)
• Deep vein thrombosis (blood clot formation in the legs or arms)
• Kidney failure
• Liver failure
• Death (rare)

After Procedure

• You will be kept in the intensive care unit (I.C.U) for the first one or two days after surgery. During this period, you will be kept on a ventilator to keep your lungs expanded and the body well-oxygenated. Once the ventilator will be removed, you will be fully conscious and can start moving around and eating slowly.
• Most patients will stay in the hospital for up to one week following a hepatectomy.
• It is normal to feel soreness and tiredness after the procedure. These symptoms should subside in about two weeks after surgery.
• The doctor will recommend painkillers to ease the discomfort.
• The sutures will be removed one to two weeks after surgery.
• Follow-up appointments with the doctor are recommended to evaluate the results of the procedure.

Home remedies:

• Recovery at home may take about four to eight weeks. You may need to take time off from work during this time.
• Avoid heavy lifting and strenuous activities during the recovery period.
• Recovery following laparoscopic or robotic surgery is quicker and takes approximately two to four weeks, but it may take up to six to eight weeks before you can resume your normal activities.
• Avoid alcohol consumption to protect your liver.
• Perform light exercises like walking regularly.
• Your doctor will guide you when it is safe to have a bath and resume sex.

Cost of hepatectomy in India- 

The cost of hepatectomy in Mumbai is between INR 5,00,000 to INR 7,50,000.
The cost of hepatectomy in Delhi is between INR 4,50,000 to INR 7,00,000.
The cost of hepatectomy in Bangalore is between INR 4,50,000 to INR 7,00,000.
The cost of hepatectomy in Chennai is between INR 4,00,000 to INR 6,50,000.