A liver resection is surgery to remove a portion of the liver, most commonly to treat cancer or other growths. Unlike most organs, the liver can regrow to its original size after a large piece is removed, which makes this surgery possible even when surgeons need to take out a significant amount of tissue. The procedure ranges from removing a small wedge of tissue to taking out an entire lobe, depending on the size and location of the problem.
Why Liver Resection Is Performed
The most common reason for liver resection is cancer. This includes primary liver cancer (hepatocellular carcinoma), bile duct cancer, and metastases from other cancers that have spread to the liver, particularly colorectal cancer. For colorectal cancer that has spread to the liver, surgical removal remains one of the most effective treatments, with five-year survival rates reaching 50% to 60% for patients with one to three metastases and as high as 71% in carefully selected patients who have all visible cancer removed.
Benign (noncancerous) conditions can also require resection. Large liver hemangiomas, which are tangles of blood vessels, may need removal when they grow beyond 5 cm and cause progressive abdominal pain. Liver adenomas, a type of benign tumor more common in women taking oral contraceptives, are generally recommended for surgical removal when they exceed 3 cm or when there’s concern about cancerous transformation. In general, benign liver tumors warrant surgery when they cause symptoms, carry a risk of becoming malignant, or when imaging can’t confidently rule out cancer.
Types of Liver Resection
Liver resections fall into two broad categories: major and minor. A major resection removes more than three of the liver’s eight functional segments. A minor resection takes out a smaller portion.
- Lobectomy (hepatectomy): A major resection that removes either the right or left lobe of the liver. The right lobe is larger, so a right hepatectomy removes more tissue.
- Segmentectomy: A minor resection that removes one or two specific segments along with a margin of healthy tissue around the tumor.
- Wedge resection: A minor resection that removes a small, wedge-shaped piece of liver containing the tumor and a rim of normal tissue, without following the liver’s segmental boundaries.
- Left lateral sectionectomy: A minor resection that removes the outer portion of the left lobe, one of the most commonly performed smaller liver surgeries.
How Surgeons Decide You’re a Candidate
Before surgery, your medical team needs to answer two questions: can the tumor be fully removed, and will enough healthy liver remain afterward? The workup typically includes contrast-enhanced CT scans and high-quality MRI of the liver to map the tumor’s size, location, and relationship to blood vessels. Blood tests assess how well the liver is currently functioning, including measures of clotting ability, bilirubin, albumin, and liver enzymes. Doctors also evaluate for portal hypertension (high pressure in the liver’s blood supply), which can signal that the liver is already under strain.
The critical safety threshold is the “future liver remnant,” the percentage of functioning liver that will remain after surgery. Most centers require at least 20% to 25% of liver volume to stay behind in patients with a healthy liver. If the liver has been injured by chemotherapy, that minimum rises to about 30%. For patients with significant scarring or cirrhosis, surgeons typically want at least 40% remaining. When the remnant would be too small, doctors can sometimes use a technique called portal vein embolization before surgery to redirect blood flow and stimulate the side that will remain, encouraging it to grow larger before the operation.
Open, Laparoscopic, and Robotic Approaches
Traditional open surgery uses a large abdominal incision that gives the surgeon direct access and clear visibility. This remains the standard for large tumors and anatomically complex cases. Laparoscopic (minimally invasive) surgery uses several small incisions and a camera to guide the operation, but it works best for smaller, more accessible tumors and requires advanced surgical expertise and specialized equipment.
Robotic-assisted surgery is increasingly available for major liver resections. Compared to open surgery, robotic approaches tend to result in less blood loss (roughly half as much), fewer overall complications, and shorter hospital stays. In one study comparing the two approaches, patients who had robotic surgery stayed an average of 9 to 10 days versus 13 to 15 days for open surgery. The tradeoff is a longer time in the operating room. Long-term cancer outcomes, including overall survival and disease-free survival at five years, appear comparable between the two methods.
What Recovery Looks Like
Hospital stays after a major open liver resection typically run about two weeks, though minimally invasive approaches can shorten that to roughly 9 to 10 days. The first few days involve pain management, gradual reintroduction of food, and monitoring for complications. Most people can expect to resume light daily activities within a few weeks, with full recovery taking several months depending on how much liver was removed and the surgical approach used.
The liver’s ability to regenerate is remarkable. Cells in the remaining tissue begin dividing within the first week, with peak cell growth happening around days 7 to 10 after surgery. The liver typically restores its full volume within about three months, though complete functional recovery can take three to six months. Even after a 70% removal, the remaining portion can roughly double in size to compensate. Blood markers of liver function often return to normal within 7 to 10 days, even before the organ has finished regrowing.
Potential Complications
Liver resection is a major operation, and complications are not uncommon. In a study of over 500 patients, the most frequently observed issues included:
- Bile leak: The most common complication, occurring in roughly 14% of cases. This happens when bile seeps from the cut surface of the liver. Most bile leaks are minor and resolve on their own or with drainage, but severe leaks can extend the hospital stay significantly and increase the risk of other problems.
- Surgical site infection: Affects about 9% of patients overall, though that rate jumps to 20% in patients who also develop a bile leak.
- Post-operative bleeding: Occurs in roughly 5% to 6% of cases.
- Liver failure after surgery: Happens in about 5% of patients, when the remaining liver can’t keep up with the body’s needs. This is the complication surgeons work hardest to prevent through careful preoperative planning.
The 90-day mortality rate in that same study was 2.6% overall. Patients who developed bile leaks had a notably higher mortality rate of 7.1%, compared to 1.9% for those without. The severity of complications correlates directly with how much liver is removed, the patient’s baseline liver health, and whether they received chemotherapy before surgery.
Long-Term Outcomes for Cancer
For colorectal liver metastases, which represent one of the largest groups of patients undergoing liver resection, survival depends on several factors. Patients with fewer metastases (one to three) and disease confined to one side of the liver tend to do best, with five-year survival rates above 50%. When metastases affect both lobes, five-year survival is still meaningful at around 46%. The location of the original colon cancer matters too: metastases from left-sided colon cancers carry a five-year survival near 52%, while those from right-sided colon cancers have a lower rate of about 27%.
Genetic markers in the tumor also play a role. Patients with certain mutations in the RAS gene pathway have a five-year survival around 47% after resection. Newer blood-based monitoring tools that detect circulating tumor DNA are helping doctors identify which patients are at highest risk for recurrence. Patients who remain negative on these blood tests during follow-up have five-year survival rates around 80%, compared to 50% for those who test positive.