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HEPATOBILIARY ONCOLOGY
Liver Metastases Resection
Surgical removal of liver secondaries — hepatic resection for colorectal liver metastases and other secondary liver tumours offers the best chance of long-term survival for carefully selected patients.
ABOUT THE PROCEDURE
Surgery for Liver Metastases — From Diagnosis to Cure
Liver metastases — secondary tumours that have spread from a primary cancer to the liver — were once considered incurable. Today, surgical resection of colorectal liver metastases (CRLM) offers 5-year survival rates of 40–60% in selected patients, making hepatic surgery the most effective treatment for this condition.
The key principle of liver resection for metastases is achieving an R0 resection (clear margins) while preserving adequate functional liver volume (future liver remnant, FLR ≥25–30% of total liver volume). Modern liver surgery has moved away from anatomical segment-based resections to parenchyma-preserving “oncosurgery” — removing the tumour with a margin, preserving as much normal liver as possible.
Techniques including portal vein embolisation (PVE) to induce contralateral liver hypertrophy, two-stage hepatectomy, and ablative therapies (microwave ablation) complement formal resection in complex cases.
How It Is Performed
Multi-disciplinary Assessment
CT volumetry, FLR calculation, assessment of distribution and number of metastases, primary tumour control, response to neoadjuvant chemotherapy (FOLFOX/FOLFIRI).
Portal Vein Embolisation (if needed)
When FLR is <25%, the portal vein to the lobe being resected is embolised to induce hypertrophy of the remnant liver (2–4 weeks before surgery).
Hepatic Resection
Anatomical or non-anatomical parenchyma-sparing resection with intraoperative ultrasound guidance. CUSA (ultrasonic dissector) used for parenchymal transection. Pringle’s manoeuvre as needed.
Adjuvant Treatment & Surveillance
Post-operative chemotherapy for synchronous CRLM. CT surveillance at 3–6 monthly intervals. RAS/RAF mutation status guides targeted therapy decisions.
CANDIDACY
Who May Benefit?
Colorectal cancer liver metastases
The most common and best-studied indication. Up to 4–6 metastases resectable in favourable cases; resectability defined by FLR and distribution, not number alone.
Neuroendocrine tumour liver metastases
Resection or debulking (≥90% of disease removed) for symptomatic or growing neuroendocrine liver metastases provides significant palliation and survival benefit.
Other resectable liver secondaries
Selected cases of liver metastases from GIST, adrenocortical carcinoma, or other solid tumours may warrant resection in specialist MDT settings.
Oligometastatic disease after systemic control
Patients achieving disease control with systemic therapy who develop limited liver metastases may transition from palliative to curative intent with resection.
M.Ch AIIMS · HPB SURGERY
Hepatic Surgery Training at AIIMS
Dr. Imaduddin trained in hepatic oncological surgery as part of his M.Ch at AIIMS, one of the highest-volume HPB centres in India, with experience in major hepatectomy, anatomical resections, and combined colorectal-liver procedures.
Find Out If Your Liver Metastases Are Resectable
Resectability assessment for liver metastases requires specialist expertise. Dr. Imaduddin provides consultations for liver secondary tumours in Hyderabad and offers second opinions for patients told that liver surgery is not possible.