Liver Lobectomy

Part of the liver removed. The rest grows back within months.

In the OSLO-COMET trial, keyhole liver resection caused complications in 19 percent of patients against 31 percent after open surgery, with the same clear margins.

How the liver is divided

Surgeons divide the liver into eight segments, each with its own blood supply and bile drainage, which allows them to remove one part while the rest keeps working. A right hepatectomy removes segments five to eight, 60 to 65 percent of the liver, and a left hepatectomy removes segments two to four. An extended resection, sometimes called a trisectionectomy, removes even more, and a segmentectomy or wedge removes only a small area. The healthy liver regenerates. Few other organs can do this. The remaining part begins to grow within days and recovers most of its volume within a few months, which is why a person can lose more than half the liver and live normally, with blood tests returning to normal within weeks in most cases and the regrown liver working as well as the original one. A liver scarred by cirrhosis regrows less well, and a liver damaged by months of chemotherapy may need time to recover, so the surgeon checks liver function and quality before deciding how much can safely come out.

The liver is the only organ that regrows after a large part is removed.

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Why the operation is done

Common reasons include

• metastases from colorectal cancer confined to the liver,
• hepatocellular carcinoma in a liver with enough reserve,
• cholangiocarcinoma, a cancer of the bile ducts inside or at the hilum of the liver,
• neuroendocrine tumor metastases,
• and benign tumors such as a large adenoma or a symptomatic hemangioma.

Removal is planned by a team, never by the surgeon alone.

Making sure enough liver remains

The portion left behind, the future liver remnant, must be large enough to keep you well while it regrows. At one American cancer center, 301 consecutive patients had an extended right hepatectomy after their remnant was measured on CT. Liver insufficiency followed in 15 percent overall. It caused 61 percent of the deaths, and it was clearly more frequent when the standardized remnant was 20 percent or less of the total liver. A remnant above 20 percent proved sufficient in a healthy liver, and patients whose small remnant was enlarged first did as well as those who started with enough.

Results for bowel cancer metastases

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In 1,001 consecutive patients who had liver resection for colorectal metastases at Memorial Sloan Kettering, surgical mortality was 2.8 percent, survival was 37 percent at five years and 22 percent at ten. Survival depended on five factors known before surgery, and patients with up to two of them did well.

1. Node-positive primary bowel cancer.
2. Less than 12 months from the bowel cancer to the liver metastases.
3. More than one liver tumor.
4. A largest tumor over 5 centimeters.
5. A CEA blood level above 200.

Fewer risk factors, better long-term results.

Keyhole or open surgery

Keyhole resection suits

1. tumors at the edge of the liver,
2. left lateral and many right-sided resections in experienced hands,
3. and parenchyma-sparing operations that remove several small tumors.

In Norway, the OSLO-COMET trial randomized 280 patients with colorectal liver metastases to keyhole or open liver-sparing resection. Complications within 30 days occurred in 19 percent after keyhole surgery and 31 percent after open surgery, the hospital stay was 53 hours against 96, and blood loss, operating time and clear margins were the same. Costs were equal too.

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How the operation is done

Risks and how they are managed

Measure first, then cut.

The recovery

After a major resection, patients spend the first night in intensive care or a high-dependency unit, where nurses watch blood pressure, urine output, blood sugar and liver tests closely, then walk the next day and start drinking early. Hospital stay runs two to four days after keyhole liver-sparing surgery and five to ten days after an open right hepatectomy. Blood tests show the liver recovering day by day. Tiredness is the main complaint for six to eight weeks while the liver regrows, and many patients need an afternoon rest for the first month. Appetite returns gradually, so small, protein-rich meals help, and alcohol is best avoided until the liver has recovered. Lifting waits six weeks after an open operation. Breathing exercises with a small device, taught by the physiotherapist, protect the lungs after an incision under the ribs. Chemotherapy, when planned, starts four to eight weeks after surgery, once the wound has healed and blood tests have returned to normal.

How long to stay in Istanbul

Plan for two weeks.

A published Istanbul package for an open left hepatectomy lists five nights in hospital including intensive care, and covers the surgery, preoperative tests, pathology and transfers, while the platform's overview gives seven to ten days in hospital and fourteen days in Turkey. Pathology results arrive within a week. We discuss them with you before you fly. Fitness to fly is confirmed at the final visit. Bring clot prevention for the flight.

What decides the cost

Extent of resection, keyhole or open surgery, portal vein embolization, intensive care nights, imaging and pathology set most of the figure.

A quote you can compare names the operation, any embolization and the stay, and that figure comes only after a liver surgeon reviews your CT or MRI, blood tests and cancer history. The review costs nothing.

Arranging the trip

Your CT or MRI, pathology and chemotherapy history, shared on WhatsApp, open the review, and the coordinator who replies stays with you through the operation and the follow-up after you return. The team speaks English, Arabic, French, Russian, Serbian, Romanian and Spanish, and interpreters cover other languages. A relative stays with you on the companion bed in your room. The international office books a hotel, sends the visa invitation letter ten days before travel and arranges transfers, with halal, vegetarian and diabetic meals, a prayer room and a female physician on request.

Once you are back home

Scans every three to six months for the first two years, with blood tests such as CEA for bowel cancer or AFP for liver cancer at the same visits, look for recurrence in the liver or elsewhere, and a new tumor in the regrown liver can often be treated with a second resection or with ablation, because the liver tolerates repeat surgery well. Our hospital gives chemotherapy on the same site, or it continues near home.

Fever, yellowing of the eyes or skin, a swelling abdomen, increasing pain, or bile-stained fluid from the wound. Each needs a doctor the same day.

Liver lobectomy FAQ