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Hepatectomy - Surgery, Procedure Steps, Types, Results

Medically Reviewed by
Dr. K R Vasudevan
Liver Resection Surgery (Hepatectomy)

Treatment Duration

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2 Hours

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4 Hours

Treatment Cost

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2,00,000

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4,50,000

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Liver Resection Surgery (Hepatectomy)
Medically Reviewed by Dr. K R Vasudevan Written by Sparshi Srivastava

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A study by Shetty and Kellarai, 2022, revealed that the incidence of hepatocellular carcinoma (primary liver cancer) in India ranges between 1 and 7.5 per 100,000 people. Hepatectomy is a surgical option that can significantly improve outcomes and survival rates by removing the diseased portions of the organ. 

A common concern is, “Will the liver grow back after hepatectomy?” Continue reading to find out. We will also discuss the procedure, complications, and recovery of this liver resection technique. 

Procedure NameHepatectomy 
Alternative NameLiver resection surgery
Conditions TreatedCancerous and benign liver tumours, gallstones, liver cysts
Benefits of the ProcedureMinimally invasive options, quick recovery, less bleeding
Treated ByHepatobiliary surgeons

About Hepatectomy

Hepatectomy meaning in simpler terms is the surgical removal of a portion of the liver. Depending on the requirements of the procedure, it can be performed either laparoscopically or through an open approach. 

Anatomy and Physiology of the Liver

The liver is located in the upper right part of the abdomen. It gets blood via the hepatic artery and the hepatic portal vein. The organ is divided into two lobes, subdivided into thousands of small lobules. 

The liver performs numerous vital functions essential for maintaining overall health. Some of these include:

  1. Detoxification: The liver filters and removes toxins from the blood.

  2. Blood Clotting: It produces clotting factors necessary to prevent excessive bleeding.

  3. Metabolism: The liver processes carbohydrates, proteins, and fats, converting them into energy.

  4. Bile Production: It produces bile, a digestive fluid that breaks down fats in food.

  5. Storage: The organ stores essential vitamins and minerals, releasing them into the bloodstream as needed.

Types of Hepatectomy

Type 

Description 

Major Liver Resection (right or left hepatectomy)

Removes the right or left lobe of the liver (hemihepatectomy)

Minor Liver Resection 

  1. Segmental or wedge resection 

  2. Left lateral sectionectomy

Multiple Liver Resection 

Multiple tumours are resected at the same time 

Two-stage Liver Resection 

  1. Part of the tumour is removed in the first operation

  2. The remaining tumours are extracted after sufficient liver regeneration

Each type of hepatectomy is selected based on the location, size, and severity of the liver disease and the patient’s overall health. The goal is to remove the damaged tissue while preserving healthy liver tissue.

Conditions Treated With Hepatectomy

Hepatic resection treats various malignant, precancerous, and benign tumours. These include the following: 

  1. Hepatocellular Carcinoma: Excision of primary cancerous tumours from the liver. 

  2. Metastatic Colorectal Surgery: A cancer treatment that has propagated to the liver from the colon or rectum. 

  3. Cholangiocarcinoma: Extracting cancers originating in the bile ducts within the liver.

  4. Intrahepatic Stones: Surgical removal of gallstones in the bile ducts inside the organ. 

  5. Benign Liver Tumours: Removing non-cancerous growths, such as adenomas, that may cause symptoms or complications.

  6. Liver Cysts: Treatment for symptomatic or large cysts that may result in pain or interfere with liver function.

Who needs hepatectomy? 

Hepatectomy may be necessary for individuals experiencing symptoms that indicate severe liver conditions. These physical manifestations can include:

  1. Persistent pain in the abdomen 

  2. Jaundice (yellowing of the eyes and skin because of liver dysfunction)

  3. Tiredness and lack of energy

  4. Loss of appetite 

  5. Early satiety (feeling full quickly after eating small amounts of food)

  6. Lump in the upper right abdomen 

The surgery is also performed for individuals who want to donate a part of their liver for living donor liver transplantation

Benefits of Hepatectomy

The surgical removal of liver is called a hepatectomy. The laparoscopic technique offers various benefits over the traditional approach. The advantages of the procedure are as follows: 

  1. Laparoscopic procedures use small incisions, which result in less scarring. 

  2. Patients typically experience less post-operative pain compared to open surgery.

  3. Shorter hospital stays and quicker recovery times allow individuals to return to normal activities sooner.

  4. Minimally invasive techniques often result in less blood loss during surgery. 

  5. Advanced imaging and instruments used in laparoscopic surgery provide surgeons with a clearer view and greater precision

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Before and On the Day of Hepatectomy

Hepatectomy is a major procedure that requires thorough planning and careful coordination. Knowing what to expect before and on the day of surgery can help ease anxiety and streamline the process.

Before Hepatectomy 

Parameters

Prerequisites

Pre-op Assessments

  1. Blood tests (liver function tests)
  2. Imaging studies (CT, MRI, ultrasound)
  3. Liver biopsy

Risk Evaluation

  1. Allergies
  2. Risks vs benefits

Restrictions

  1. Blood-thinning medications a week before the procedure
  2. Smoking 4-6 weeks prior to the surgery
Anaesthesia SelectionGeneral
Fasting6-8 hours before surgery

Before a hepatectomy, patients undergo thorough evaluations to assess their eligibility for the surgery. The doctor provides detailed instructions regarding fasting, medication adjustments, and smoking cessation.

On the Day of Hepatectomy

Parameters

Prerequisites

Consent

Mandatory

Surgical Preparation

  1. Changing into a hospital gown
  2. Shaving the surgical site if necessary

Physical Evaluation

Vitals check-up (breathing, heart rate, blood pressure)

IV Line

Yes, for fluids and medications

Patient Positioning

Supine reverse Trendelenburg (lying on the back with head raised higher than the feet)

On the day of hepatectomy, patients must provide mandatory consent and change into a hospital gown. An IV line is placed, and the patient is positioned supine reverse Trendelenburg.

Hepatectomy Procedure

The exact procedure of the liver resection surgery varies depending on the type of surgery. It usually takes about two to six hours to complete and involves the following steps: 

  1. The patient is given general anaesthesia to ensure they are unconscious and pain-free throughout the surgery.

  2. For open surgery, the surgeon makes a large incision across the abdomen. The surgeon makes four to six keyhole cuts if a patient has laparoscopic surgery. These are used to insert the camera and surgical instruments. 

  3. They use an intraoperative ultrasound to confirm the location and extent of the diseased tissue.

  4. The liver is exposed, and the blood flow is temporarily blocked using metallic clips or staplers to reduce the risk of bleeding. 

  5. The surgeon removes the diseased part of the liver. For laparoscopic surgery, they make an additional incision of 2 to 5 inches to extract the resected liver. 

  6. The cut is closed with sutures or staples, and a dressing is placed over the wound.

After Hepatectomy and Recovery

Will the liver grow back after resection? Remarkably, the liver can regenerate, often restoring itself to its original size within four to six weeks after surgery. During this time, recovery involves careful monitoring and support to ensure proper healing and liver function.

In-Hospital Recovery 

Patients may need to stay in the hospital after the liver removal surgery for up to a week. They can expect the following during this time: 

  1. Some patients may be shifted to an intensive care unit after surgery, where they stay for one or two days. 

  2. The medical team closely monitors the individual’s vital signs, electrolyte balance, and blood loss. 

  3. Once their condition stabilises, the patient is moved to a general ward or private room. 

  4. The doctor prescribes pain medications to manage discomfort.  

  5. Patients are allowed to drink fluids the next day after surgery. A normal diet is resumed over the next few months.

  6. They are encouraged to move around to prevent blood clots. 

At-Home Recovery 

Recovery after a liver operation takes about four to eight weeks. The laparoscopic technique offers a quick recovery, lasting about two to four weeks. Guidelines to be followed at home are as follows: 

  1. Take all prescribed medications as directed. 

  2. Shower instead of bathing and pat dry the wound. 

  3. Avoid heavy lifting or strenuous activities for six weeks after surgery. 

  4. Quit smoking and alcohol. Adhere to any lifestyle changes recommended by the medical team.

Individuals can expect to resume normal activities 12 weeks after an open surgery and six to eight weeks after the laparoscopic method. 

First Follow-Up Appointment 

The doctor schedules the first follow-up appointment two weeks after surgery. During this visit, they assess the patient’s recovery and check for any signs of complications. They will also conduct blood tests to monitor liver function and detect any abnormalities. 

Risks and Complications of Hepatectomy

Hepatectomy is a major surgery that has certain risks and potential complications. Understanding these is crucial for patients considering the procedure

  1. Bleeding: Due to the extensive blood supply of the liver, there is a significant risk of blood loss during and after surgery. 

  2. Infection: Like any surgical procedure, infection can occur at the incision site or within the chest. 

  3. Bile Leakage: Bile can leak from the liver or bile ducts, causing pain and fever. 

  4. Ascites: It is the accumulation of fluid in the abdomen, which can lead to discomfort and the need for additional treatments. 

  5. Blood Clots: Patients can develop these due to a lack of mobility after the surgery. If the blood clot becomes loose and travels through the bloodstream, it can cause serious complications like pulmonary embolism. 

  6. Liver Failure: Removing a large portion of the liver can lead to this complication, especially if the remaining liver tissue is not healthy or sufficient.

When to call a doctor? 

After a left or right hepatectomy, patients should seek medical attention when they experience any concerning symptoms. These include the following: 

  1. Persistent fever 

  2. Unusual bleeding or discharge from the incision site 

  3. Vomiting or diarrhoea 

  4. Constipation for more than three days 

  5. Swelling in the abdomen 

  6. Jaundice (yellowing of the skin or eyes) 

Risks of Delaying Hepatectomy

Delaying a hepatectomy when it is medically indicated can cause several serious risks and complications. These are as follows:

  1. Cancerous tumours can proliferate and metastasise, complicating their surgical removal. 

  2. Symptoms such as pain, jaundice, and digestive issues can worsen over time, significantly impacting the patient’s quality of life.

  3. As the disease progresses, the remaining healthy tissue may become insufficient to maintain normal liver function, leading to liver failure.

Cost of Hepatectomy

The liver surgery cost in India can vary depending on several factors. The price starts from ₹ 2 lakhs and goes up to ₹ 4.5 lakhs. The average expense of the procedure is ₹ 3.2 lakhs.

Procedure Name 

Estimated Cost 

Hepatectomy 

₹ 2 lakhs to 4.5 lakhs

The following factors can affect the cost of hepatectomy: 

  1. Surgeon’s Expertise: Specialists with more experience charge a higher fee.

  2. Hospital Facilities: The cost differs between public and private hospitals, as well as the level of care and facilities provided.

  3. Geographic Location: The procedure is costlier in metropolitan cities than in smaller towns. 

  4. Post-operative Care: The length of hospital stay and the need for intensive care or additional treatments can increase expenses.

  5. Insurance: The extent of coverage offered by health insurance can affect out-of-pocket expenses.

Takeaway

Hepatectomy is a surgical procedure that treats liver disease or tumours. While it carries certain risks, the benefits of removing diseased tissue often outweigh the potential complications. Timely intervention and proper post-operative care are crucial for a successful recovery.

HexaHealth provides access to top healthcare professionals. We offer detailed information about life expectancy after liver resection and help you understand your options. Our team ensures you receive personalised and effective care tailored to your needs.

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Frequently Asked Questions (FAQ)

Hepatectomy, meaning in the medical sense, is the surgical removal of a portion of the liver. This procedure is performed to treat liver tumours, cancers, or other serious liver conditions. It eliminates diseased tissue and improves liver function.

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Hepatectomy treats various liver conditions. These include the following: 

  1. Liver cancer (hepatocellular carcinoma)

  2. Metastatic liver cancer

  3. Benign liver tumours

  4. Symptomatic liver cysts

  5. Bile duct cancer (cholangiocarcinoma)

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A liver resection, or hepatectomy, is performed under general anaesthesia. It involves the following steps: 

  1. Making an incision in the abdomen

  2. Removing the diseased liver tissue

  3. Controlling bleeding

  4. Closing the incision with sutures or staples

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Like any other surgery, hepatic resection carries certain risks and complications. These include: 

  1. Bleeding

  2. Infection

  3. Liver failure

  4. Bile leakage

  5. Blood clots

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Recovery time after a hepatectomy varies, but patients stay in the hospital for up to a week. Complete recovery can take 12 weeks, during which individuals gradually resume normal activities. 

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Before a liver operation, the doctor provides various instructions for preparation. The guidelines are mentioned below: 

  1. Undergoing preoperative assessments like blood tests and imaging studies

  2. Stopping blood thinners a week before

  3. Avoiding smoking for 4-6 weeks

  4. Fasting for 6-8 hours before surgery

  5. Discussing any allergies or risks with the doctor

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The success rate of hepatectomy varies depending on the type of liver condition, patient’s condition and overall health. Generally, the procedure has a high success rate. According to a study by Sano et al., 2018, the five-year survival rate for non-colorectal liver metastasis is up to 41%. 

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It is common to experience certain side effects after a hepatectomy. These may include the following: 

  1. Post-operative pain

  2. Fatigue

  3. Nausea

  4. Changes in liver function

  5. Infection

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The liver surgery cost in India varies widely based on factors like the complexity of the surgery, hospital facilities, and insurance coverage. However, it can range from ₹ 2 to ₹ 4.5 lakhs. Patients should consult HexaHealth experts for accurate prices. 

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Post-operative care is an important phase of the patient’s recovery. It includes the following guidelines: 

  1. Regular follow-up appointments

  2. Managing pain with prescribed medications

  3. Maintaining a balanced diet

  4. Avoiding strenuous activities

  5. Watching for signs of complications such as infection or liver dysfunction

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Yes, the liver has a remarkable ability to regenerate. After a hepatectomy, the remaining liver tissue can grow back to its original size within four to six weeks, restoring its functions.

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After a partial hepatectomy, patients are advised to eat a balanced diet high in proteins, vitamins, and minerals. They should avoid alcohol, fatty foods, and processed foods. It is essential to follow dietary guidelines provided by their doctor. 

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Most individuals can resume their normal activities 12 weeks after surgery. Recovery is quicker for laparoscopic surgery, ranging from about six to eight weeks. 

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Patients who experience signs of complications require immediate medical attention. These include the following: 

  1. Fever

  2. Severe pain

  3. Persistent nausea or vomiting

  4. Excessive bleeding or discharge from the wound

  5. Jaundice

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The prognosis after a hepatectomy depends on the extent of the surgery, the underlying condition, and the patient’s overall health. According to a study by Wee et al., 2022, life expectancy after liver resection for giant hepatocellular carcinoma (HCC) (≥10 cm) shows promising outcomes. The 5-year survival rate exceeds 25%.

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Liver removal can be safe for elderly patients, but it depends on their overall health and comorbidities. A study conducted by Galun et al., 2021, revealed that the overall morbidity rate after liver resection for individuals aged 70 and above was 46.2%. Appropriate patient selection is important to ensure a successful outcome.

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Surgical removal of liver is highly effective for treating liver cancer, especially when tumours are localised. It can significantly improve survival rates, with some patients achieving long-term remission.

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There are various alternatives to hepatectomy. The treatment choice depends on the tumour size, location, and patient’s overall health. Options include:

  1. Liver transplantation

  2. Radiofrequency ablation

  3. Transarterial chemoembolisation (TACE)

  4. Targeted therapy

  5. Immunotherapy 

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Yes, the right or left hepatectomy can be performed laparoscopically. It offers the following benefits:

  1. Smaller incisions

  2. Reduced pain

  3. Shorter hospital stays

  4. Faster recovery

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The maximum amount of liver that can be safely resected ranges between 60% to 80%. The remaining liver must be healthy enough to regenerate and maintain essential liver functions. The exact amount depends on individual patient factors.

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References

All the articles on HexaHealth are supported by verified medically-recognized sources such as; peer-reviewed academic research papers, research institutions, and medical journals. Our medical reviewers also check references of the articles to prioritize accuracy and relevance. Refer to our detailed editorial policy for more information.


  1. Johns Hopkins Medicine. Liver: Anatomy and Functions [Internet]. Johns Hopkins Medicine. 2023. link
  2. Hepatectomy (Liver Resection) Surgery: Procedure & Recovery [Internet]. Cleveland Clinic. 2022. link
  3. Liver Lesions: Types, Causes, Symptoms & Treatment [Internet]. Cleveland Clinic. link
  4. Wee JJ, Tee CL, Junnarkar SP, Low JK, Tan YP, Huey CW, et al. Outcomes of surgical resection of super-giant (≥15 cm) hepatocellular carcinoma: Volume does matter, if not the size. Journal of Clinical and Translational Research [Internet]. 2022 May 25 [cited 2024 Jul 13];8(3):209–17. link
  5. Yamada S, Shimada M, Morine Y, Imura S, Ikemoto T, Saito Y, et al. A new formula to calculate the resection limit in hepatectomy based on Gd-EOB-DTPA-enhanced magnetic resonance imaging. PLoS ONE [Internet]. 2019 Jan 25 [cited 2024 Jul 13];14(1):e0210579. link
  6. Shetty VV, Kellarai A. Comprehensive Review of Hepatocellular Carcinoma in India: Current Challenges and Future Directions. JCO Global Oncology. 2022 Oct;(8).link

Last Updated on: 17 July 2024

Disclaimer: The information provided here is for educational and learning purposes only. It doesn't cover every medical condition and might not be relevant to your personal situation. This information isn't medical advice, isn't meant for diagnosing any condition, and shouldn't replace talking to a certified medical or healthcare professional.

Reviewer

Dr. K R Vasudevan

Dr. K R Vasudevan

MBBS, MS General Surgery, DNB Surgical Gastroenterology

25 Years Experience

Dr K R Vasudevan is a well-known Gastrointestinal Surgeon currently associated with Jaypee Hospital in Noida. He has 25 years of experience in Liver Transplant Surgery and worked as an expert in Liver Transplant and Surgical Ga...View More

Author

Sparshi Srivastava

Sparshi Srivastava

B.Tech Biotechnology (Bansal Institute of Engineering and Technology, Lucknow)

2 Years Experience

An ardent reader, graduated in B.Tech Biotechnology. She was previously associated with medical sciences secondary research and writing. With a keen interest and curiosity-driven approach, she has been able to cont...View More

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