Liver Resection Surgery in Kolkata | Hepatectomy Explained

Key points

Liver resection is used for liver cancer (HCC), colorectal cancer that has spread to the liver, bile duct cancer, some benign tumours and hydatid cysts.
In a healthy liver, up to about 70% can be removed safely; in a cirrhotic liver, much less.
When the remaining liver would be too small, portal vein embolisation can make it grow before surgery.
Many resections can be done laparoscopically; large or complex ones are often done open.
The remaining liver typically regrows over roughly 6–8 weeks, with most regeneration in the first few weeks.

Why part of the liver is removed

Hepatocellular carcinoma (HCC)

Primary liver cancer, usually arising in a liver damaged by hepatitis B, hepatitis C, alcohol or fatty liver disease. Whether to resect or transplant depends on liver function, tumour size and number — this decision is explained on the liver cancer surgery page.

Colorectal liver metastases

Bowel cancer that has spread only to the liver can often be removed, sometimes after chemotherapy, with a real chance of long-term survival. Surgery may be staged or combined with the bowel operation.

Bile duct and gallbladder cancer

Intrahepatic and hilar cholangiocarcinoma and advanced gallbladder cancer require removal of part of the liver along with the tumour.

Benign tumours

Large or symptomatic haemangiomas, hepatic adenomas (which can bleed or rarely turn malignant) and tumours whose nature is uncertain on scans. Many benign lesions, including most haemangiomas and FNH, need no surgery at all.

Hydatid cysts

Cysts caused by the dog tapeworm (Echinococcus), seen in people with contact with dogs and livestock. Treated with albendazole plus surgery to remove the cyst, taking care not to spill its contents.

How much liver can be removed?

The key measurement is the future liver remnant (FLR) — the volume of liver that will remain after surgery, calculated from a CT scan as a proportion of total liver volume. Commonly used thresholds are:

Widely used guide figures; the decision also depends on blood tests, liver function studies and the patient's overall fitness.
Condition of the liver	Minimum remnant usually needed
Normal, healthy liver	About 20–25%
Liver injured by prolonged chemotherapy or significant fatty liver	About 30%
Liver with fibrosis or compensated cirrhosis	About 40% or more — and only if liver function and portal pressure allow

In cirrhosis, even a small resection can tip the liver into failure if there is significant portal hypertension, a low platelet count or a raised bilirubin. That is why patients with cirrhosis are assessed by a team that does both liver resection and liver transplant, so the safer path can be chosen.

When the remnant is too small: portal vein embolisation

The portal vein brings most of the liver's blood. In portal vein embolisation (PVE), an interventional radiologist, working through a needle in the skin under local anaesthesia and sedation, blocks the branch supplying the part of the liver that will be removed. Blood is diverted to the side that will stay, which grows over the following 3–6 weeks. A repeat CT confirms whether it has grown enough.

PVE also acts as a test: a liver that fails to grow after embolisation is unlikely to regenerate well after surgery. Other strategies include combining PVE with hepatic vein embolisation, or doing the operation in two stages. For some cancers, chemotherapy is continued while waiting so the tumour is controlled.

Types of resection, and open versus laparoscopic

Non-anatomical (wedge) resection: a small piece around a surface tumour.
Segmentectomy: removal of one or two of the liver's eight segments, following its blood supply.
Right or left hepatectomy: removal of one half of the liver.
Extended (tri-sectional) hepatectomy: removal of about two-thirds or more, often needing PVE first.

Laparoscopic (keyhole) liver resection is well established for tumours on the front and edges of the liver and for many segmentectomies and hemi-hepatectomies at experienced centres. It usually means less pain, fewer wound problems and a shorter hospital stay. Open surgery remains appropriate for very large tumours, tumours near the major veins, resections needing bile duct or vessel reconstruction, and repeat operations. The approach is chosen for safety first, not incision size.

Risks of liver resection

Complication	What it is	How it is handled
Bile leak	Bile seeping from the cut surface	Usually settles with the drain; sometimes needs a radiological drain or ERCP stent
Post-hepatectomy liver failure	The remaining liver cannot keep up: rising bilirubin, clotting problems, fluid, confusion	Intensive care support while the liver regenerates; it is the main reason remnant volume is planned carefully
Bleeding	During or after surgery	Modern techniques have reduced transfusion needs; re-operation is rarely needed
Fluid in the abdomen or chest	Particularly in patients with cirrhosis	Diuretics, drainage if needed
General risks	Chest infection, wound infection, blood clots	Early walking, breathing exercises, clot prevention

The overall risk ranges widely — a small laparoscopic wedge in a healthy liver carries low risk, while an extended hepatectomy with bile duct reconstruction carries substantially more. Your surgeon should explain the risk for your specific operation.

Recovery and regeneration

1
In hospital
One or two days of close monitoring, then walking and eating. Typical stay is about 3–5 days after laparoscopic surgery and about 6–10 days after a major open resection.
2
Weeks 1–4
Tiredness is common as the liver regrows. Short walks daily, a normal protein-rich diet, and no alcohol.
3
Weeks 4–8
Most people return to desk work and driving. Heavy lifting is avoided for about six weeks after laparoscopic and around three months after open surgery.
4
Follow-up
Blood tests and scans at intervals; for cancer, oncology review and surveillance for several years.

Regeneration restores liver volume and function, not the original shape. Living donors go through the same process — see can you live with half a liver.

Liver surgery with Dr Bappaditya Har

Dr Har performs open and laparoscopic liver resection at Narayana RN Tagore Hospital, Mukundapur, Kolkata, as part of a liver transplant and HPB surgery practice. Because the same team also performs transplants, patients with liver cancer on a background of cirrhosis can be assessed for both options at one place. Share CT or MRI reports on WhatsApp at +91 70420 39420, or call 080675 06860.

Frequently asked questions

Can the liver grow back after surgery?

Yes. A healthy liver regains most of its volume within about 6–8 weeks after resection. A cirrhotic liver regenerates much less well, which limits how much can be removed.

How much of the liver can be removed safely?

In a healthy liver, up to about 70–75% can be removed if the remaining part has good blood supply and drainage. With chemotherapy damage, fatty liver or cirrhosis, more must be left behind.

Is liver resection a major operation?

It ranges from a relatively small laparoscopic procedure to a very major open operation. The extent depends on the tumour's size and position and the condition of the liver.

Is laparoscopic liver surgery safe?

In suitable patients at experienced centres, laparoscopic liver resection has outcomes comparable to open surgery, with less pain and a shorter stay. Not every tumour is suitable.

Should I have resection or a transplant for liver cancer?

It depends on whether the liver is cirrhotic, how well it works and the number and size of tumours. This is covered on our liver cancer surgery page.

What is portal vein embolisation?

A radiological procedure that blocks blood flow to the part of the liver to be removed, so the remaining part grows larger before surgery, making a major resection safer.

Liver Resection (Hepatectomy) Surgery in Kolkata