Liver Surgery Program

About the Program

The Liver Surgery Program at Massachusetts General Hospital provides state-of-the-art surgical treatment for both cancerous and non-cancerous liver diseases. Our surgeons conduct a high number of liver surgeries, approximately 145 per year, and research has shown that outcomes improve when patients are treated in high-volume facilities.

Each patient's treatment plan is developed and managed by a multidisciplinary team of experts from various departments and divisions at Mass General, including:

• Surgery
• Cancer Center
• Transplant Center
• Vascular Interventional Radiology
• Gastrointestinal Interventional Radiology
• Hepatology
• Gastroenterology

We bring together the expertise of these groups in the management of patients with liver diseases.

Thanks to the integration of our multidisciplinary teams, patients are seen by providers from multiple specialties during the same visit. This allows patients and their care team to develop a definitive plan for treatment options.

Advanced Surgical Techniques for Treatment of Liver Cancer

The Liver Surgery Program at Mass General offers expert liver surgery in the context of a multidisciplinary team. Patients with liver tumors are evaluated in multidisciplinary sessions at the Tucker Gosnell Center for Gastrointestinal Cancer. If you have cancer you will meet with a surgeon, medical oncologist and radiation oncologist, all specializing in primary liver cancers or cancers which travel to the liver. Your X-rays will be reviewed by a liver radiologist, and the pathology slides will be reviewed by a liver pathologist. If all your records can be reviewed, we will provide you with definitive treatment recommendations by the end of the clinic visit. The members of the Mass General multidisciplinary liver team are world renowned experts in the care of cancers of the liver and will offer participation in state-of-the-art treatments.

Specialized treatments offered by our liver surgeons include:

• Advanced approaches for tumors invading critical vascular structures which require removal of the whole liver and then re-implantation into the body
• Conventional and complex surgery for removal of benign liver masses and tumors in the liver and bile duct
• Irreversible electroporation of liver tumors in which a current of electricity is directed to malignant cells to damage them and prevent growth
• Laparoscopic placement of separators to allow for safer radiation of liver tumors, so that masses can be downsized and an operation can be performed
• Laparoscopic removal of liver tumors, where thin instruments are inserted into the abdomen through tiny holes, resulting in a shorter hospital stay and faster recovery times
• Microwave or radiofrequency ablation of liver tumors, a minimally invasive procedure that uses heat to destroy cancer cells
• PET MRI and other advanced imaging modalities to determine the extent of the liver mass or cancer
• Placement of a specialized chemotherapy pump (hepatic artery infusion pump) which can infuse chemotherapy directly into the liver for cancers which cannot be removed from the liver. These pumps allow for high doses of chemotherapy with minimal side effects in other areas of the body

What to Expect

Your initial consultation at Mass General, is often with a multidisciplinary team. During this time, physicians from different specialties will review your medical history, X-rays and reports.

We ask that you bring the following to your appointment:

• Any imaging and pathology reports
• List of medications, vitamins and herbal supplements that you take, including their dosages

If you have had additional scans performed at another hospital, we ask that you bring those scans on disks (this is not necessary if your scans were performed at Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Newton-Wellesley Hospital or Salem Hospital).

With your care team, you will discuss treatment options, as well as the risks and benefits. Our aim during the consultation is to give you the information you need to make an informed decision. For this reason, many physicians with different specialties will be included in your visit.

Mass General Difference

Mass General is consistently recognized among the best hospitals in the country by U.S. News & World Report. Our ranking is based on our quality of care, patient safety and reputation in over a dozen different specialties. Our commitment to excellence means that we work to ensure that you receive the best care at all points during your visit. Our doctors are leaders within their respective fields, and collaborate with colleagues in various departments across the hospital. As a patient, you benefit from shared expertise, leading research, and our commitment to quality and excellence.

Cancer and Non-Cancerous Liver Masses

The liver surgeons at Mass General are highly specialized, highly experienced and nationally recognized experts. Our surgeons have undergone specialty training in liver and bile duct operations or transplantation, and offer the highest degree of specialization and expertise. Liver operations are complex and published data have demonstrated that hospitals and surgeons with the highest volume and experience have the lowest complication and death rates. The higher number of operations performed by surgeons can lead to better outcomes.

Working within a team of medical oncologists, radiation oncologists and hepatologists at the Liver Mass Center and Tucker Gosnell Center for Gastrointestinal Cancer within the Mass General Cancer Center, liver surgeons perform conventional to complex surgeries, using:

• Advanced surgical techniques to resect high risk liver masses, including ex-vivo resections (taking the liver out of the body, removing a mass and putting it back in)
• Hepatic artery infusion pumps for unresectable liver cancers
• High-dose radiation with either protons or photons to downstage liver cancers so patients can undergo an operation
• Microwave or radiofrequency ablation of liver tumors, a minimally invasive procedure that uses heat to destroy cancer cells
• Minimally invasive operations, including laparoscopic and robotic liver resections
• Nanoknife (irreversible electroporation) where an electric current destroys cancer cells
• Research

Liver Resection

Many patients are candidates for surgical removal (resection) of their liver tumors, which is the treatment approach associated with the highest chance of a cure. Liver tumors include those which started in the liver and bile ducts and those cancers which travel to the liver. Liver resections are generally considered complex surgeries and published data have consistently demonstrated that hospitals and centers with the highest liver surgery volume experience the lowest complication and death rates. Mass General performs more liver resections than any other hospital in Massachusetts.

Surgeons at Mass General are skilled in new techniques that minimize blood loss during surgery, reducing the need for blood transfusions. The average hospital stay following major liver resection has been reduced to two to five days because of many of these advances. Laparoscopic liver resections are associated with an even shorter length of stay. During a liver resection, portions of the liver are removed. The liver then regenerates itself within three to eight weeks. It is often necessary to remove the gallbladder as well.

For patients with unresectable liver tumors, treatment options include:

• Chemoembolization or yttrium 90, which infuses either chemotherapy or radiation directly into the blood vessels that feed liver tumors
• High-dose radiation
• Microwave or radiofrequency ablation
• Liver transplantation

Our team has worked with colleagues in radiology to develop the most sensitive tests for detection of liver tumors, as well as tests that allow precise mapping of liver volumes for operative planning. Our surgeons are also experienced in performance of intraoperative ultrasound examinations of the liver, which has been demonstrated to be the most sensitive method for detection of liver tumors.

Preparing for Surgery

You may be asked to come in for some pre-operative work such as blood work, chest X-rays or an EKG. In most cases, you will meet with an anesthesiologist beforehand to discuss your care.

Depending on the type of liver surgery, a patient may stay at Mass General for one to six days, and will require four to eight weeks of recovery time at home or in a rehabilitation center. During this period, very light activity is recommended. Your surgeon will discuss a recovery plan specific to your condition and surgery.

Your surgeon will schedule a follow-up visit two weeks after your surgery to assess your progress and discuss your treatment plan further.

Research and Innovation

As an academic medical center, Mass General invests in research and clinical trials to better understand liver diseases and develop innovative approaches to prevention and treatment.

Clinical Trials

Our multidisciplinary cancer care teams have developed novel and encouraging clinical trials for patients who need options behind standard care. Clinical trials often introduce or combine novel new treatment strategies with ones that are known to be effective.

Learn more

Surgical Outcomes for the Liver

The Center for Outcomes & Patient Safety in Surgery (COMPASS) ensures that surgical data is transparent and accessible for patients. Watch the video to view Mass General's performance for procedures to treat conditions of the liver.

Learn more about COMPASS