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Division of Surgical Oncology
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The Liver Surgery Program at Massachusetts General Hospital provides state-of-the-art surgical treatment for diseases of the liver. Our surgeons conduct a high number of liver surgeries, 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 the Cancer Center, Transplant Center, Vascular Interventional Radiology, Gastrointestinal Interventional Radiology and Gastroenterology. We bring together the expertise of surgeons, radiologists and pathologists in the management of liver disease.
The liver surgeons in the Division of Surgical Oncology at Mass General are highly specialized, highly experienced and nationally recognized experts. Our surgical oncologists have undergone additional specialty training in oncology, and offer the highest degree of specialization and expertise. Liver surgery is a generally complex surgery and published data have demonstrated that hospitals and surgeons with the highest volume and experience with specific operations have the lowest complication and death rates. Recognizing the relationship between frequency of performing an operation and the quality of outcomes, each surgeon in the Division of Surgical Oncology focuses his or her clinical practice on the management of one or two diseases.
Working within a team of medical oncologists, radiologists and hepatologists at the Tucker Gosnell Center for Gastrointestinal Cancer within the Mass General Cancer Center, liver surgeons perform conventional to complex surgeries, using:
As an academic medical center, Mass General invests in research to better understand disease and develop innovative approaches to prevention and treatment.
We are currently conducting research in the use of medications as prevention in those identified as being high-risk for liver cancer. Additionally, opportunities to participate in other research may be available. Your surgeon can discuss these options with you.
Your initial consultation with one of our liver surgeons will take approximately one hour. During this time, your doctor will review your medical history, X-rays and reports. We ask that you bring any imaging and pathology reports, along with a 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 North Shore Medical Center). Treatment options, as well as their risks and benefits, will be discussed in detail. Our aim during the consultation is to give you the information you need to make an informed decision.
Mass General is consistently ranked 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.
You will need a referral from your primary care physician to make an appointment. You may request an appointment online or call 617-643-6146. Once your request is received, a patient coordinator will contact you to schedule your first appointment.
The Liver Surgery Program at Massachusetts General Hospital 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, where they can meet with a surgeon, medical oncologist, radiologist and hepatologist; have their X-rays and pathology slides reviewed; and receive definitive treatment recommendations in a single visit. The members of this multidisciplinary team are on the leading-edge in care of cancers of the liver and offer participation in many clinical trials. Specialized treatments offered by our liver surgeons include:
Many patients are candidates for surgical removal (resection) of their liver tumors, which is the treatment approach associated with the highest chance for a positive outcome. 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. These techniques include: lowering the central venous blood pressure during surgery, radiofrequency energy during dissection and use of surgical staplers. The average hospital stay following major liver resection has been reduced to five or six days as a result of many of these advances. Laproscopic 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 six to eight weeks. It is often necessary to remove the gallbladder as well.For patients with unresectable liver tumors, treatment options include:
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.
Radiofrequency ablation is a treatment that can be applied to some liver tumors that are not able to be removed through surgery. The technique involves placement of a thin electrode (similar to a needle) into the center of a liver tumor, usually with the assistance of either CAT scan or ultrasound imaging. This is usually less invasive than a surgical procedure since the electrode can be inserted through the skin. Local anesthesia is commonly used to minimize the discomfort of electrode insertion. The electrode is then connected to an electrical generator, and as current passes from the electrode tip to a grounding pad, the tumor is heated to a point where it is destroyed. The procedure generally does not involve significant discomfort for the patient.
During radiofrequency ablation, vital signs, tumor temperature and electrical properties of the tumor are monitored. The procedure takes approximately two to four hours. Some patients may need to stay the night.
Light activity is recommended for a few days following the procedure. The effectiveness of treatment is assessed by CAT scan one month following treatment. Re-treatments are often necessary. Risks of the procedure include bleeding, although this is extremely rare.
In November of 1996, Kenneth Tanabe, MD, and Nahum Goldberg, MD, performed the first radiofrequency ablation of a patient with a liver tumor in the United States. This history-making procedure was performed in the operating rooms of Mass General as part of an Institutional Research Board-approved clinical research protocol. The experimental procedure was deemed a success in both efficacy and safety. Following this initial trial, researchers in the Division of Surgical Oncology at Massachusetts General Hospital have continued to lead the way in making advances in this field.
Our team is also developing gene therapies for unresectable liver tumors, including a clinical trial of herpes simplex viral treatment of liver tumors. The development of a living-related liver transplant program by transplant surgeons allows for liver transplantation to suitable patients in a more timely fashion and avoids relatively long wait times associated with cadaveric organs.
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 three to ten days, and will require six to eight weeks of recovery time at home or in a rehabilitation center. During this period, very light activity is recommended.
Your surgeon will schedule a follow-up visit two weeks after your surgery to assess your progress, and discuss your treatment plan further.
Tumors are abnormal masses of tissue that form when cells begin to reproduce at an increased rate. The liver can grow both non-cancerous (benign) and cancerous (malignant) tumors.
Kathleen Corey, MD, director of the Massachusetts General Hospital Fatty Liver Clinic and co-director of the Mass General Weight Center, discusses the link between obesity and the rise in liver diseases such as nonalcoholic steatohepatitis (NASH) and nonalcoholic fatty liver disease.
Learn more about general anesthesia in this educational video.
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