ENLiver resection is an operation that removes part of the liver together with a tumour or other lesion. The liver is the only internal organ that regrows its volume after partial removal, and all liver surgery rests on that. Liver resection in Germany is carried out at centres of hepatobiliary surgery, meaning surgery of the liver and bile ducts.
Below: who needs the operation, how surgeons check the liver will cope, the types of operation, recovery, hospitals and arrangements. It covers the operation, not liver cancer as a whole: see liver cancer treatment in Germany.
Surgery for liver cancer: when a resection is needed
Surgery for liver cancer is needed when the whole tumour can be removed and enough working liver remains. Among cancers of the liver itself, this means hepatocellular carcinoma (cancer arising from liver cells) with preserved liver function, and cancer of the bile ducts inside the liver.
Another reason is metastases, deposits spread to the liver from a tumour elsewhere, above all bowel cancer. With a limited number of deposits, removing them is part of the plan together with chemotherapy; the tumour board decides whether chemotherapy comes first. See treatment of liver metastases.
Benign lesions, such as an adenoma or large lesions causing symptoms, are removed only for clear reasons. In advanced cirrhosis the remaining liver may fail, so a liver transplant is discussed instead, or non-surgical options such as destroying the tumour through a needle.
Will the remaining liver be enough? Preparing the operation
Whether enough liver will remain is worked out before surgery, from scans and blood tests. Contrast CT and MRI show where the lesions lie in relation to vessels and bile ducts; the same images give the volume of the future liver remnant (volumetry).
Function matters as much as volume. It is assessed with blood tests and special tests such as the LiMAx breath test: a test substance is injected into a vein, and the exhaled air shows how fast the liver processes it.
If the remnant would be too small, it is “grown” first: the branch of the portal vein on the tumour side is blocked from inside (embolisation), and the healthy part enlarges over several weeks. Sometimes surgery is split into two stages so the kept part can grow in between. A multidisciplinary board of surgeon, hepatologist, radiologist and oncologist decides.
Types of liver operation
Liver operations are anatomical or non-anatomical. The liver has eight segments, each with its own vessels, so it can be divided along the borders of its blood supply. An anatomical resection removes one or more segments or half the liver (hemihepatectomy); a non-anatomical one removes a small area around the lesion.
Surgery is open, through an incision, or minimally invasive: laparoscopic through small cuts, or robotic. The choice depends on the location and number of lesions and on previous operations. Keyhole surgery is not better for everyone; the surgeon decides case by case.
During the operation the surgeon can also destroy a small deep lesion by thermal ablation (heat delivered through a needle electrode) and checks the margins with ultrasound directly on the liver. The German Cancer Research Center’s Krebsinformationsdienst describes surgical treatment in its section on liver cancer (in German).
After the operation: recovery and risks
Recovery starts in hospital: usually the first day or so in intensive or high-dependency care, then the ward; the surgeon sets the length of stay by the extent of surgery. Possible complications are bleeding, bile leakage and temporary liver insufficiency, which is why these operations belong in centres that do them regularly.
Over several months the liver regains most of its former volume. Check-up blood tests and scans follow, and for tumours further cancer treatment and follow-up continue as planned by the board. You can fly home once the surgeon agrees.
Where liver resection is performed in Germany
Liver resection is done at experienced centres across Germany. In Munich, Prof. Helmut Friess is Director of the Department of Surgery at Rechts der Isar Hospital, which covers visceral (abdominal) surgery, including the liver and bile ducts, and transplantation. At Leipzig University Hospital, Prof. Daniel Seehofer leads hepatobiliary surgery and abdominal organ transplantation.
In Frankfurt, Prof. Christoph Heidenhain heads the Department of General and Visceral Surgery at Agaplesion Markus Hospital, whose fields include liver surgery. Barmherzige Brüder Hospital Munich has a liver cancer centre with gastroenterologist Prof. Christian Rust, surgeon PD Dr. Johann Spatz and radiologist PD Dr. Tobias Jakobs. Choose the centre by the nature of the lesions and the state of the liver, not by the city.
Frequently asked questions
Does the liver grow back after a resection?
Yes. The remaining tissue grows, and over several months the liver regains most of its former volume. In the first days it must also do the work of the removed part, so blood tests are watched closely. A cirrhotic liver has less in reserve and recovers less well, so the extent of removal is planned with particular care.
Can a liver resection be done by keyhole surgery?
Yes, if the situation allows: laparoscopic and robotic liver resections are increasingly common. The route does not suit everyone, as it depends on the location and number of lesions, previous operations and the team’s experience and equipment. Neither approach suits all, and the surgeon decides after studying the scans.
When can I fly home after liver resection in Germany?
You can fly home once the surgeon considers it safe; the timing depends on the extent of the operation, how you feel and your test results. You leave with a discharge letter describing the operation, the histology if ready, and recommendations. Check-ups at home follow the hospital’s plan, and further tumour treatment is agreed with an oncologist.
How AlenMed arranges liver resection
AlenMed starts with your documents, translating them and referring them to liver surgeons across Germany: reports and discs of contrast CT and MRI, histology if available, liver function tests and discharge letters on earlier treatment. The answer says whether surgery is possible and whether preparation is needed.
There is no single price: the hospital issues an estimate (Kostenvoranschlag) after reviewing the documents, and the page on cancer treatment costs in Germany explains what the bill includes. AlenMed arranges the visa invitation, an interpreter, accommodation for a companion near the hospital and a follow-up plan for home. AlenMed’s office is in Munich; partner hospitals are all over Germany.
This material is for information only and is not an offer. The treatment plan is set by the doctor at an in-person consultation.
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