Liver metastasis is the presence of a tumor mass in the liver or liver tissue as a consequence of the extension of a cancer already located in another organ or tissue of the organism.
This extension can be:
- Single nodule
- Many nodules
- One mass
- Several masses
The difference between nodule and mass is that the nodule size is less than 4-5 cm, while the mass is larger than 4-5 cm.
Causes of liver metastasis
Metastasis occurs because the cancer cells reach the liver through the blood, either ischemic or through blood circulation. The most frequent sites that generate tumor by liver metastasis are cancers of the colon and rectum and in general digestive cancers (pancreatic cancer, stomach cancer, small intestine cancer, etc.). However, any tumor from any part of the body is susceptible when it spreads to liver metastasis.
Surgical techniques for liver metastases
Surgical techniques for the treatment of liver metastasis can be understood according to two distinct classifications:
- Extent of the surgical intervention performed: it can be major or minor hepatectomy (liver resection). In major hepatic resections, three or four hepatic segments are removed (the liver is divided into eight hepatic segments that differ in that each one has its arterial, venous and biliary drainage).
- Approach: it can be open or laparoscopic. The open approach refers to conventional incisions that are usually extensive under the ribs on the right side. Laparoscopy is a minimally invasive surgery performed through small incisions of between 0.5 and 2 centimeters through which the liver segments with metastases are removed. Not all liver resections can be performed laparoscopically, but there are some segments that are more favorable for this option.
Indications for liver metastasis surgery
The type of liver resection depends on the location of the liver metastasis and the number of liver metastases. For the minimally invasive surgical approach, single metastases located in peripheral liver segments are ideal.
In the case of major liver resections or the removal of a large tumor mass, the priority is always patient safety, and the open approach allows greater vascular control and better control of blood loss.
In general, open surgery is indicated for most cases of liver resection. Laparoscopic surgery is reserved for selected cases of patients with small, localized lesions in favorable segments.
Duration of surgery for liver metastases
The duration will depend on the type of resection and the surgical approach used:
- Minor open resections: between 90 minutes and three hours on average.
- Major open resections: between three and five hours.
However, the duration will always depend on the surgeon’s experience and the type of material used, key elements in liver surgery so that the patient’s results are as favorable as possible.
Postoperative period for liver metastasis surgery
When the procedure is performed by experienced teams and in high-volume hospital centers, the postoperative course of patients is favorable. The hospital stay after surgery (provided there are no complex vascular resections) usually lasts between three and five days. Laparoscopic surgery usually minimizes postoperative pain, although it has not been demonstrated that it shortens the patient’s hospital stay. In short, surgery for liver metastases can nowadays be considered a highly safe surgery with an excellent postoperative course when performed by experienced surgeons and in high volume centers.