Surgery for Liver Cancer

Surgery, either with surgical resection (removal of the tumor) or a liver transplant, offers the best option to cure liver cancer, if it can be done. Surgery may not be possible if the tumor is large and takes up too much of the liver, the liver is too damaged, the cancer has spread outside of the liver, or if you have other serious illnesses.

Partial hepatectomy

Partial hepatectomy is surgery to remove part of the liver. To have this surgery, people generally need to have a good liver function, good overall health, and have a single tumor that has not grown into blood vessels.

Imaging tests such as CT or MRI are done first to see if the cancer is resectable – that is, if it can be removed completely. Still, sometimes during surgery the cancer is found to be too large or has spread too far to be removed, and the surgery that was planned cannot be done.

For some people who have unresectable liver cancer, using other treatments first might shrink the tumor enough so that surgery could then be an option.

In the United States, most people with liver cancer also have cirrhosis. For someone with severe cirrhosis, removing even a small amount of normal liver tissue at the edges of a cancer might not leave enough healthy liver behind to perform important functions.

People with cirrhosis might still be eligible for surgery if there is only one tumor (that has not grown into blood vessels) and they will still have a reasonable amount of liver function left once the tumor is removed. Doctors often assess this function by assigning a Child-Pugh score (see Liver Cancer Stages), which is a measure of cirrhosis based on certain lab tests and symptoms.

People in Child-Pugh class A are most likely to have enough liver function to have surgery. People in class B are less likely to be able to have surgery. Surgery is not typically an option for people in class C.

After surgery, the remaining section of liver takes over the functions of the entire liver. A healthy liver may grow back to its normal size over time.

Possible risks and side effects

Liver resection is a major, serious operation that should only be done by skilled and experienced surgeons. People with liver cancer usually have other liver problems besides the cancer. In this case, surgeons have to remove enough of the liver to get all of the cancer, but also leave enough behind for the liver to function.

  • Bleeding: A lot of blood passes through the liver, and bleeding after surgery is a major concern. Also, the liver normally makes substances that help with blood clotting. Damage to the liver (both before the surgery and during the surgery) can add to potential bleeding problems.
  • Infection
  • Complications from anesthesia
  • Blood clots
  • Pneumonia
  • New liver cancer: Because the remaining liver still has the underlying disease that led to the cancer, sometimes a new liver cancer can develop afterward.

Liver transplant

When it is available, a liver transplant may be the best option for some people with liver cancer.

Liver transplants can be an option for those with tumors that cannot be removed with surgery, either because of the location of the tumor(s) or because the liver has too much disease for the person to tolerate removing it all.

In general, a transplant might be an option to treat people with small tumors that have not grown into nearby blood vessels.

Rarely, a transplant can also be an option for people with cancers that can be removed completely. Possible advantages of a transplant in this setting are that the risk of getting a new liver cancer is much lower, and the new liver will function normally. But this has to be weighed against the complexity and possible long-term side effects of a liver transplant.

How common are liver transplants?

Unfortunately, there are only a limited number of donor livers available for transplant each year, and most of these are used for people with diseases other than liver cancer. Increasing awareness about the importance of organ donation is an essential public health goal that could make this treatment available to more people with liver cancer and other serious liver diseases.

Where do liver organ donations come from? 

Most livers used for transplants come from people who have just died. But some people can get part of a liver from a living donor (usually a close relative) for a transplant. The liver can regenerate some of its lost function over time if part of it is removed. Still, the surgery does carry some risks for the donor.

People needing a transplant must wait until a liver becomes available, which often can take too long for some people with liver cancer. In many cases a person may get other treatments, such as embolization or ablation, while waiting for a liver transplant. Or doctors may suggest surgery or other treatments first and then a transplant if the cancer comes back.

Possible risks and side effects

Like partial hepatectomy, a liver transplant is a major operation with serious risks and should only be done by skilled and experienced surgeons. Possible risks include:

  • Bleeding
  • Blood clots
  • Complications from anesthesia
  • Problems from a weakened or suppressed immune system: People who get a liver transplant need to take medicines to prevent their bodies from rejecting the new organ. These drugs have their own risks and side effects, especially the risk of getting serious infections. Suppressing the immune system might also allow any liver cancer that had spread outside of the liver to grow even faster than before. Some of the drugs used to prevent rejection can also cause high blood pressure, high cholesterol, and diabetes; can damage the bones and kidneys; and can increase the risk of getting a new cancer.
  • Rejection of the new liver: After a liver transplant, regular blood tests are done to check for signs of the body rejecting the new liver. Sometimes liver biopsies are also taken to see if the new liver is being rejected and if changes are needed in the drugs that can prevent it.

More information about surgery

For more general information about surgery as a treatment for cancer, see Cancer Surgery.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.

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Developed by the American Cancer Society medical and editorial content team with medical review and contribution by the American Society of Clinical Oncology (ASCO).

Last Revised: February 11, 2025

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