LIVER & PANCREAS SURGERY

Operations on the liver and pancreas are mainly done for cancer. These are generally major operations with a 1 week stay in hospital & an anticipated 1-2 month recovery time.

Liver surgery

Operations on the liver can be done for a variety of reasons but generally involve removing a portion of the liver containing a tumour.
Most liver surgery performed is to remove secondary cancers in the liver that have spread from the bowel (stage 4 colorectal cancer disease).
Other reasons for liver surgery include:

1. primary liver cancer
2. benign tumours that are symptomatic.
3. indeterminate lesions (where we are not sure if the lump is cancer or not)
4. removing part of the liver with the bile duct/gallbladder (bile duct and gallbladder cancers)
5. secondary cancers (non colorectal) e.g. neuroendocrine ; GIST; breast cancer secondaries etc.

The operation involves following the liver protocol which Dr Ahmed’s staff will provide you. A link for this will be found at the bottom of the page.
The operation can be done with a large incision or with keyhole surgery. This will depend on which part of the liver is being removed; and your previous medical and surgical history.
The operation will usually take a few hours to do and you will go to intensive care after the procedure.
Your length of stay in hospital is usually 1 week with 1-2 months for full recovery thereafter. If there are any complications these time frames will lengthen.

There are general and specific risks for liver surgery
The specific risks include :

1. mortality – risk of dying is 1-2%. This can occur due to massive bleeding and/or liver failure.
2. liver dysfunction/liver failure. This can occur if the remaining liver is not capable of providing adequate function to the body. It can be temporary(dysfunction) or permanent (liver failure). the remaining liver is important and its function is based on the volume of liver plus its quality. Cirrhosis and chemotherapy can damage the quality of the liver such that its important to maintain an adequate volume of liver.
3. bile leak – the liver makes bile and this can leak from the cut edge surface. generally most bile leaks will dry up with time as the liver heals. Some bile leaks can cause infection; and may require an endoscopic procedure (ERCP) to decompress the biliary tree with a stent being placed.
4. bleeding – bleeding from the liver or inflow vessels is uncommon after the operation. It is possible for bleeding to occur such that a return to the operating theatre would be required to stop the bleeding.
5. infection/collections. this is usually related to a bile leak or a leak from the bile duct/bowel join (hepaticojejunostomy)
6. respiratory complications – pneumonia – if pain control is not adequate this can cause the patient not to depending breath as well ; which will result in the lung becoming collapsed which can lead to atelectasis/pneumonia.
7. bowel injury/fistula – This can occur if there are dense adhesions which are present from previous surgery. These adhesions can also occur following previous liver surgery. Dense adhesions involving the bowel could lead to an inadvertent bowel injury which if not recognised at the time of surgery could leak to infection; fistula and the need for further surgery & prolonged hospitalisation.

Pancreas surgery

Operations on the pancreas are related to cancer and benign tumours. There are 2 main procedures:

1. Whipples
2. Distal pancreatectomies

There are other minor variants of the above involving pancreatic resections.

Risks:

1. pancreatic leak- this can occur in up to 25% patients following pancreas surgery. Pancreatic juice will usually leak into a drain and will be evident by a high amylase/lipase enzyme result on the drain fluid. The drain analysis is usually done on day 3 but the colour/volume of the fluid in the drain is quite important to note. A leak in itself is ok but if the juice becomes activated it can lead to infection and bleeding.
2. bleeding – this can occur following a leak. It may require a return to the operating theatre but angio embolisation (X-ray procedure)
3. infection/collections – this may require drains to be placed percutaneously ( X-ray procedure)
4. delayed gastric emptying – this may involved the stomach not working well enough and a tube (nasogastric tube – from your nose through to the stomach) maybe present for some time – days to weeks.
5. mortality – risk of dying is between 1-5%.