{"id":8155,"date":"2024-05-14T09:00:22","date_gmt":"2024-05-14T01:00:22","guid":{"rendered":"https:\/\/asiamd.com\/?p=8155"},"modified":"2025-08-20T11:49:51","modified_gmt":"2025-08-20T11:49:51","slug":"keyhole-surgery-for-liver-cancer","status":"publish","type":"post","link":"https:\/\/asiamd.bqubetech.com\/id\/2024\/05\/14\/keyhole-surgery-for-liver-cancer\/","title":{"rendered":"Keyhole Surgery for Liver Cancer"},"content":{"rendered":"

This article has been fact-checked by Dr Lee Lip Seng<\/a>, general surgeon at LS Lee Surgery,\u00a0 Mount Elizabeth Novena Specialist Centre, Singapore.<\/span><\/i>
\nAbout the Doctor<\/a><\/p>\n

Keyhole surgery, also known as laparoscopic surgery, is a minimally invasive surgical <\/span>technique used in various medical fields, including the treatment of liver cancer. This <\/span>article explores the diagnosis of liver tumors, criteria for surgical removal, treatment <\/span>\u00a0<\/span>modalities for liver cancer, and the specific benefits of laparoscopic surgery.<\/span>\u00a0<\/span><\/p>\n

\n

Follow us on WhatsApp for the latest updates: https:\/\/bit.ly\/AsiaMDWhatsAppEN\u00a0<\/i><\/b><\/a><\/p>\n<\/blockquote>\n

<\/h2>\n

1.\u00a0 <\/span>Liver Tumor: Benign or Malignant?<\/span>\u00a0<\/span><\/h2>\n

Determining whether a liver tumor is benign or malignant is crucial for guiding treatment <\/span>\u00a0<\/span>strategies. The diagnosis involves a combination of <\/span>i<\/span>maging studies, blood tests, <\/span>\u00a0<\/span>presence of risk factors for liver cancer and biopsy. <\/span>\u00a0<\/span><\/p>\n

(a) Imaging Studies\u00a0<\/strong><\/p>\n

Imaging modalities such as ultrasound, computed tomography (CT), and magnetic <\/span>\u00a0<\/span>resonance imaging (MRI) are the first steps in evaluating liver lesions. These <\/span>\u00a0<\/span>techniques help in assessing the size, location, and characteristics of the tumor, <\/span>\u00a0<\/span>providing valuable clues about its nature.<\/span>\u00a0<\/span><\/p>\n

(b) Biopsy\u00a0<\/strong><\/p>\n

A biopsy involves extracting a small tissue sample from the liver tumor under the <\/span>\u00a0<\/span>guidance of imaging techniques. The sample is then examined under a microscope to <\/span>\u00a0<\/span>determine the presence of cancer cells. This method is considered the gold standard for <\/span>\u00a0<\/span>diagnosing liver cancer. However, this is not always performed due to the risk of tumor <\/span>\u00a0<\/span>seedings and the spread of cancer when the biopsy is performed.<\/span>\u00a0<\/span><\/p>\n

(c) Blood Tests\u00a0<\/strong><\/p>\n

Blood tests, including the measurement of alpha-fetoprotein (AFP) levels, can support <\/span>\u00a0<\/span>the diagnosis of liver cancer. Elevated AFP levels are often associated with <\/span>\u00a0<\/span>hepatocellular carcinoma (HCC), the most common type of liver cancer. On the other <\/span>\u00a0<\/span>hand, patients with cancer spread from the colon to the liver commonly have raised <\/span>carcinoembryonic antigen (CEA).\u00a0<\/span><\/p>\n

(d) Risk Factors\u00a0<\/strong><\/p>\n

The risk factors for liver cancer (HCC) include any conditions that can cause liver scarring or hardening resulting in liver cirrhosis (e.g. Hepatitis B infection, alcoholic liver cirrhosis and fatty liver).\u00a0<\/span><\/p>\n

<\/h2>\n

2. <\/span>Criteria for Surgical Removal in Liver Cancer<\/span>\u00a0<\/span><\/h2>\n

The selection of liver cancer patients for surgical removal is a critical and highly specific <\/span>\u00a0<\/span>process, influenced by a detailed assessment of the cancer’s characteristics, the patient’s <\/span>\u00a0<\/span>overall liver function, and the presence or absence of metastasis. Below are the refined <\/span>\u00a0<\/span>criteria focusing explicitly on liver cancer:<\/span>\u00a0<\/span><\/p>\n

(a) Type and Stage of Cancer\u00a0<\/strong><\/p>\n

    \n
  • Hepatocellular Carcinoma (HCC): Surgical resection is commonly considered for <\/span>patients with early-stage HCC. This is because early-stage HCC is often <\/span>localized and can be completely removed with surgery.<\/span><\/span><\/li>\n
  • Metastatic Liver Cancer: In certain cases where the liver cancer has originated <\/span>from another primary site (metastatic liver cancer), surgery might still be an <\/span>option if the cancer is limited to a few small areas in the liver and the primary <\/span>\u00a0<\/span>cancer is under control.<\/span><\/li>\n<\/ul>\n

    (b) Liver Function\u00a0<\/strong><\/p>\n

      \n
    • Adequate Liver Reserve: Successful liver surgery requires remaining liver tissue <\/span>to be sufficient to support life. This is often assessed using the Child-Pugh score, <\/span>which evaluates liver function based on total bilirubin, serum albumin levels, <\/span>\u00a0<\/span>prothrombin time, the presence of ascites, and encephalopathy. Only patients <\/span>\u00a0<\/span>with good liver function (Child-Pugh A) are typically considered for surgery.<\/span> Adequate liver reserve requires both good liver function and adequate future liver <\/span>\u00a0<\/span>remnant (i.e. adequate remnant liver volume after resection)<\/span><\/li>\n<\/ul>\n

      (c) Tumor Size and Location\u00a0<\/strong><\/p>\n

        \n
      • Operable Tumors: Successful tumor resection needs to ensure cancer is <\/span>removed completely and the patient still has adequate future liver remnant. <\/span>Patients with no liver cirrhosis and good liver function can survive even with only <\/span>30% of future liver remnant.\u00a0<\/span><\/li>\n
      • Vascular Invasion: The absence of major vascular invasion (e.g. involvement of <\/span>the main portal vein, hepatic artery or inferior vena cava) is crucial. Tumors that <\/span>encase or invade major blood vessels are often deemed inoperable due to the <\/span>higher risk of complications.<\/span><\/span><\/li>\n<\/ul>\n

        (d) Absence of Widespread Disease\u00a0<\/strong><\/p>\n

          \n
        • Localized Disease: Surgery is considered most effective for patients whose <\/span>cancer has not spread beyond the liver. This determination is typically made <\/span>using advanced imaging techniques, such as PET scans or CT scans. These <\/span>\u00a0<\/span>scans help to ensure that there is no distant metastasis, which would generally <\/span>\u00a0<\/span>preclude the benefit of surgical removal of the liver tumor.<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

          <\/h2>\n

          3. <\/span>Treatment Modalities for Liver Cancer<\/span>\u00a0<\/span><\/h2>\n

          Liver cancer, including primary forms such as hepatocellular carcinoma (HCC) and <\/span>\u00a0<\/span>secondary (metastatic) cancers, requires a multifaceted approach to treatment. The <\/span>\u00a0<\/span>choice of therapy depends on several factors, including the stage of the cancer, the <\/span>overall liver function, and the health status of the patient. Here is a more detailed look at <\/span>\u00a0<\/span>the treatment options specifically tailored for liver cancer:<\/span>\u00a0<\/span><\/p>\n

          (a) Surgical Resection\u00a0<\/strong><\/p>\n

          This involves the surgical removal of the cancerous part of the liver. It is most effective <\/span>\u00a0<\/span>in patients with localized tumors and good liver function, without significant cirrhosis or <\/span>\u00a0<\/span>other liver diseases. Resection is considered curative for small, well-defined tumors that <\/span>\u00a0<\/span>have not invaded blood vessels or spread outside the liver.<\/span>\u00a0<\/span><\/p>\n

          (b) Liver Transplantation\u00a0<\/strong><\/p>\n

          Transplantation offers hope for patients with early-stage liver cancer who have severe <\/span>\u00a0<\/span>liver dysfunction, typically due to underlying cirrhosis. The criteria for transplantation in <\/span>\u00a0<\/span>liver cancer patients include the UCSF criteria. This approach aims to remove all <\/span>\u00a0<\/span>cancerous cells and replace the liver with a healthy one, potentially curing the cancer <\/span>and the liver disease.\u00a0<\/span><\/p>\n

          (c) Ablation Therapy\u00a0<\/strong><\/p>\n

          Ablation destroys liver tumors without removing them. Techniques like radiofrequency <\/span>ablation (RFA) and microwave ablation (MWA) use heat to kill cancer cells. Ablation is\u00a0<\/span>suitable for patients with small tumors (typically less than 3 cm) who may not be <\/span>candidates for surgery due to their location within the liver or because of poor liver <\/span>\u00a0<\/span>function.<\/span>\u00a0<\/span><\/p>\n

          (d) Embolization Therapy\u00a0<\/strong><\/p>\n

          This method targets tumors’ blood supply, essential for their growth and survival. <\/span>\u00a0<\/span>Transarterial chemoembolization (TACE) combines embolization with chemotherapy, <\/span>\u00a0<\/span>directly delivering cancer-fighting drugs to the liver tumor and blocking its blood supply. <\/span>Another form, radioembolization (Y90), uses tiny radioactive beads to deliver radiation <\/span>\u00a0<\/span>directly to the tumor. These approaches are beneficial for controlling tumor growth, <\/span>\u00a0<\/span>especially in cases where surgery is not feasible.<\/span>\u00a0<\/span><\/p>\n

          (e) Targeted Therapy and Immunotherapy\u00a0<\/strong><\/p>\n

          Targeted therapies act on specific molecular targets associated with cancer cells, such <\/span>\u00a0<\/span>as sorafenib, which is approved for advanced HCC. These drugs can stop the growth <\/span>\u00a0<\/span>and spread of cancer cells while minimizing damage to healthy cells. Immunotherapy, <\/span>\u00a0<\/span>like the checkpoint inhibitors nivolumab and pembrolizumab, boosts the body’s immune <\/span>\u00a0<\/span>system to fight cancer. These treatments are options for advanced liver cancer, <\/span>\u00a0<\/span>often used when the cancer has not responded to other treatments.<\/span>\u00a0<\/span><\/p>\n

          (f) Chemotherapy\u00a0<\/strong><\/p>\n

          Traditional chemotherapy, which uses drugs to kill cancer cells, has a limited role in <\/span>\u00a0<\/span>treating liver cancer due to its effectiveness and the potential for liver damage. <\/span>\u00a0<\/span>However, hepatic artery infusion (HAI) chemotherapy delivers chemotherapy drugs <\/span>\u00a0<\/span>directly into the liver, targeting cancer cells more precisely and reducing systemic side <\/span>\u00a0<\/span>effects. This technique may be used for advanced liver cancer or when other treatments <\/span>are not suitable.\u00a0<\/span><\/p>\n

          Each of these treatments has its benefits and potential risks, and the best approach <\/span>depends on individual patient factors. A multidisciplinary team of specialists, including <\/span>\u00a0<\/span>hepatologists, oncologists, and surgeons, typically collaborates to create a personalized <\/span>\u00a0<\/span>treatment plan for each patient with liver cancer.<\/span>\u00a0<\/span><\/p>\n

          <\/h2>\n

          4. <\/span>Benefits of Laparoscopic Surgery for Liver Cancer<\/span>\u00a0<\/span><\/h2>\n

          Laparoscopic surgery, specifically tailored for the treatment of liver cancer, provides a <\/span>\u00a0<\/span>range of advantages when compared to the traditional open hepatectomy.\u00a0<\/span><\/p>\n

          (a) Enhanced Recovery and Reduced Postoperative Discomfort\u00a0<\/strong><\/p>\n

          Laparoscopic liver surgery involves making several small incisions rather than one large <\/span>\u00a0<\/span>opening. This minimally invasive approach causes less post-operative pain, faster <\/span>\u00a0<\/span>recovery, use less analgesia and minimise the risk of medication-related side effects. <\/span>\u00a0<\/span><\/p>\n

          (b) Minimized Hospital Stay Duration\u00a0<\/strong><\/p>\n

          One of the most immediate benefits observed with laparoscopic liver surgery is the <\/span>\u00a0<\/span>reduced length of hospital stay. Since the procedure is less invasive, patients recover <\/span>\u00a0<\/span>more quickly and are discharged earlier, thereby reducing potential hospital-acquired <\/span>\u00a0<\/span>infections.<\/span>\u00a0<\/span><\/p>\n

          \u00a0(c) Decreased Risk of Surgical Complications\u00a0<\/strong><\/p>\n

          The magnification provided by laparoscopic instruments allows for better visualisation <\/span>\u00a0<\/span>and precision, with lower potential risk of complications such as bleeding, infections and <\/span>\u00a0<\/span>incisional hernias associated with larger incisions in open surgery.<\/span>\u00a0<\/span><\/p>\n

          (d) Superior Cosmetic Results\u00a0<\/strong><\/p>\n

          Given that liver cancer surgery can be a major procedure, the prospect of minimal <\/span>\u00a0<\/span>scarring is a significant advantage. Laparoscopic surgery for liver cancer uses small <\/span>\u00a0<\/span>incisions, typically no more than a few centimeters in length, which result in minimal <\/span>\u00a0<\/span>scarring. This aspect is particularly valued by patients, as it lessens the physical <\/span>\u00a0<\/span>reminders of their surgery and cancer experience, contributing positively to <\/span>emotional and psychological recovery.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

          Keyhole surgery, also known as laparoscopic surgery, is a minimally invasive surgical technique used in various medical fields, including the treatment of liver cancer.<\/p>\n","protected":false},"author":9,"featured_media":8156,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"sfsi_plus_gutenberg_text_before_share":"","sfsi_plus_gutenberg_show_text_before_share":"","sfsi_plus_gutenberg_icon_type":"","sfsi_plus_gutenberg_icon_alignemt":"","sfsi_plus_gutenburg_max_per_row":"","footnotes":""},"categories":[119,168],"tags":[333,557,708,717,718,1553,1584,1637,1729,1732,1736,1771],"class_list":["post-8155","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general-surgery","category-liver","tag-cancer","tag-general-surgery","tag-laparoscopic-surgery","tag-liver-and-gallbladder","tag-liver-cancer","tag-1553","tag-1584","tag-1637","tag-1729","tag-1732","tag-1736","tag-1771"],"translation":{"provider":"WPGlobus","version":"3.0.0","language":"id","enabled_languages":["en","zh","ko","ja","mn","vi","ta","th","ms","km","id","my","hi"],"languages":{"en":{"title":true,"content":true,"excerpt":true},"zh":{"title":true,"content":true,"excerpt":true},"ko":{"title":false,"content":false,"excerpt":false},"ja":{"title":false,"content":false,"excerpt":false},"mn":{"title":false,"content":false,"excerpt":false},"vi":{"title":false,"content":false,"excerpt":false},"ta":{"title":false,"content":false,"excerpt":false},"th":{"title":false,"content":false,"excerpt":false},"ms":{"title":false,"content":false,"excerpt":false},"km":{"title":false,"content":false,"excerpt":false},"id":{"title":false,"content":false,"excerpt":false},"my":{"title":false,"content":false,"excerpt":false},"hi":{"title":false,"content":false,"excerpt":false}}},"_links":{"self":[{"href":"https:\/\/asiamd.bqubetech.com\/id\/wp-json\/wp\/v2\/posts\/8155","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/asiamd.bqubetech.com\/id\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/asiamd.bqubetech.com\/id\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/asiamd.bqubetech.com\/id\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/asiamd.bqubetech.com\/id\/wp-json\/wp\/v2\/comments?post=8155"}],"version-history":[{"count":4,"href":"https:\/\/asiamd.bqubetech.com\/id\/wp-json\/wp\/v2\/posts\/8155\/revisions"}],"predecessor-version":[{"id":10252,"href":"https:\/\/asiamd.bqubetech.com\/id\/wp-json\/wp\/v2\/posts\/8155\/revisions\/10252"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/asiamd.bqubetech.com\/id\/wp-json\/wp\/v2\/media\/8156"}],"wp:attachment":[{"href":"https:\/\/asiamd.bqubetech.com\/id\/wp-json\/wp\/v2\/media?parent=8155"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/asiamd.bqubetech.com\/id\/wp-json\/wp\/v2\/categories?post=8155"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/asiamd.bqubetech.com\/id\/wp-json\/wp\/v2\/tags?post=8155"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}