Removing the cancer from the liver by surgery is the first line of treatment to be considered. In addition to staging, liver cancers are defined additionally by how they can be treated:
- Localized resectable: the cancer is only in the liver and can be completely removed by surgery.
- Localized and locally advanced unresectable: the cancer is only in the liver, but cannot be completely removed by surgery.
- Advanced: the cancer has spread throughout the liver, or has spread to other body sites.
The best long-term outcomes for patients with liver cancer are achieved when the tumor can be completely removed. When liver resection is not feasible, microwave ablation, which uses heat to destroy the cancer, is a very attractive alternative. - Boris Kuvshinoff, MD, MBA, Chief Medical Officer, Professor of Oncology
Outcomes Better than the National Benchmark
Liver cancer surgery is highly complex and should be done only by hepatobiliary surgeons with extensive experience. Roswell Park is a high-volume center for both liver and pancreas surgery, and over the last seven years, the 30-day and in-hospital mortality for both liver and pancreas resection is less than 3 percent — better than the national average for this important quality measure.
Roswell Park offers the following surgery options for liver tumors:
- Liver resection (traditional open, minimally invasive or laparoscopic): To remove the tumors from the liver, or remove the portion of the liver that contains the tumors. If the rest of the liver is healthy, up to 80 percent of the organ can be removed. The remaining portion will regenerate.
- Microwave (MW) ablation: This can be done open or by minimally-invasive, laparoscopic techniques. Ablation may be performed in conjunction with removal of larger tumors.
- Radiofrequency ablation (RFA): Similar to how MW ablation is performed, a probe inserted into the tumor springs to emit radio waves around the tumor, heating and destroying cancer cells.
- NanoKnife irreversible electroporation, or NanoKnife IRE: This newest ablation technology destroys tumor cells using high-voltage electrical energy. Multiple probes shoot electricity between them, poking microscopic holes in the cells, enhancing cancer cell death, but does not damage surrounding ducts and blood vessels. NanoKnife is very useful for treating small tumors in difficult locations.
What About a Liver Transplant?
All Roswell Park liver cancer patients are screened to determine whether undergoing a liver transplant would be a potential treatment option. Unfortunately, the simple fact is that more than 80 percent of liver cancer patients are not candidates for this type of organ transplant. Of the select few who are candidates, only one in 10 on the liver transplant wait list receive a transplant.
Not a Candidate for Surgery?
Get a Second Opinion
We offer several neoadjuvant treatments (treatment given before surgery) such as some forms of radiation and/or chemotherapy to shrink the tumor first. Patients with advanced or borderline resectable cancers may have their tumors downsized before surgery. In addition, we offer portal vein embolization (PVE). This technique may be done in cases where the amount of healthy liver that would remain after liver surgery would be too small. PVE stimulates liver regeneration before surgery.
Neoadjuvant treatments may allow:
- Complete and curative tumor removal by surgery
- A patient who was not a surgical candidate at diagnosis, to now undergo surgery
- A decreased risk for major complications
In addition, we offer several ablation therapies for liver cancer patients who cannot undergo surgery.