Surgery & Minimally Invasive Techniques

Surgery is the preferred treatment for primary liver cancer if the tumor is confined to one area of the liver and has not spread to nearby blood vessels, and there is no underlying medical condition such as cirrhosis. If your liver cancer is more advanced, you may need other treatments, such as ablation, chemotherapy, or biologic therapy.

Memorial Sloan Kettering liver surgeons perform more than 300 operations every year. Evidence shows that patients who are treated at hospitals that perform a higher volume of liver surgeries have better outcomes and long-term survival. (1)

Our surgeons routinely offer treatment to people whose tumors are considered inoperable at other hospitals.

Surgical Techniques and Approaches

Liver surgery is a complex procedure because many of the major blood vessels leading to and from the heart pass behind or through the organ. In addition, the liver can tear easily and will bleed profusely if injured. Our surgeons have refined surgical techniques that significantly reduce blood loss and the need for transfusions during this procedure. (2)

The liver is one of two organs in the human body that has the capacity to regenerate. As much as 80 percent of the organ can be surgically removed, and within several weeks it can entirely rebuild itself. If one lobe — and its associated blood vessels — is surgically removed, the remaining lobe will compensate for the loss.

Our surgeons routinely use a technique called preoperative portal vein embolization, performed by interventional radiologists, to redirect the blood supply to the healthy portion of the liver and stimulate cell growth before surgery. (3) They also use liver-sparing surgical techniques that leave considerable portions of the healthy liver intact, which reduces the risk for complications and the need for as much of the liver to grow back.

When liver tumors are small in size and number and have not spread to nearby blood vessels – and no cirrhosis or other liver conditions are present – patients may also be eligible for a liver transplant. Our doctors can identify whether you are a good candidate for a liver transplant and coordinate with area hospitals to have this procedure done.

Minimally Invasive Therapies

At Memorial Sloan Kettering we regularly perform minimally invasive therapies that use imaging techniques such as CT, ultrasound, or MRI to guide the delivery of treatments directly to tumor sites.

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These treatments, including embolization and ablation, are performed by experts called interventional radiologists. They may be done alone or in combination with other minimally invasive therapies, before surgery, or in addition to chemotherapy.

When possible, our surgeons perform minimally invasive laparoscopic or robotic surgery to remove liver tumors. In this procedure, a thin, lighted tube with a camera on its tip is inserted through a tiny incision in the abdomen to remove tumors or, in selected cases, part of the liver.

We are evaluating the effectiveness of these minimally invasive approaches and their potential to reduce complications that can arise with traditional, open surgery. Having minimally invasive surgery can significantly reduce recovery time compared with traditional surgery, for example.

If a person’s primary liver tumors are too advanced (but have not yet spread beyond the liver), or other illnesses such as cirrhosis are present, surgical removal of the tumors may not be a good option. In cases like these, our interventional radiologists may be able to perform minimally invasive techniques using CT, ultrasound, or MRI to guide the delivery of treatments directly to the tumors.

This technique involves destroying tumors with heat or cold. Usually this type of therapy is reserved for people with three or fewer tumors. Using image guidance, the therapy is delivered through a probe inserted directly into the tumor and does not require a large incision.

There are several types of thermal ablation, including radiofrequency ablation, which uses radio waves to superheat the tumor, and cryoablation, which freezes the tumor. Other types of thermal ablation use lasers, microwaves, and focused ultrasound waves to kill tumor cells.

Although these therapies are typically delivered using image guidance, without a surgical incision, they can be delivered through a laparoscope or, more rarely, during open surgical procedures.

The selection of heat or cold depends on the size, location, and shape of your tumor. In addition, Irreversible electroporation (or IRE), a nonthermal method that uses electricity to punch holes in cancer cell membranes, can be performed with a device known as the Nanoknife.

A less commonly used form of ablation involves the injection of cancer-killing chemicals such as pure alcohol (ethanol) or acid directly into the tumor. As with thermal ablation, chemical ablation may be recommended for patients with up to three liver tumors. Chemical ablation is selected only for patients who are not candidates for thermal ablation.

The hepatic artery is the main source of blood for most liver tumors. Embolization typically involves injecting tiny particles through a small tube, or catheter, threaded into the hepatic artery. The particles block or reduce the flow of blood to the tumor, depriving it of the nutrients and oxygen it needs to survive.

Embolization can also be performed by using chemotherapy-loaded spherical particles (chemoembolization) or radio-embolization. Using this method, your doctor will inject small microspheres carrying the radioisotope Y90, which provide internal radiation therapy to the tumor.

Embolization can be repeated to treat recurrences that may develop later.