When thinking about liver cancer, there's typically two types of liver cancer. Those cancers that start, actually in the liver and those cancers that start somewhere else and then go to the liver. Those cancers that start in the liver, we call primary liver cancers. And typically, those would include such things as Hepatocellular carcinoma, or intrahepatic cholangio carcinoma. It's very common, however, for cancers to start somewhere else and then spread to the liver. Probably, the most common cancer to do this would be colon cancer, which is a very common cancer in the United States. So we frequently see patients who have colon liver metastases, colon cancer liver metastases, that is cancer that started in the colon and then later spread to the liver.
There's been significant advances in chemotherapy over the last to years. Chemotherapy typically can be delivered through different routes, either by mouth, IV, or even now through catheters that are directly placed into the liver. For a colon cancer that has spread to the liver. So, colon cancer liver metastases, there's been great advances in the use of chemotherapy to allow the tumors to be shrunk so that surgery can be possible. For other types of liver cancer such as a hepatocellular carcinoma, there's been great advances in placing catheters directly into the liver so that the tu, so that the chemotherapy can be directly delivered to the tumor. Thereby decreasing the complications and the after effects of the chemotherapy that a patient may suffer from.
When deciding whether someone is a candidate for surgical resection, we know that we can take out roughly to % of the liver. And we need to leave behind about to %. If it looks like there won't be enough liver left behind after the operation, then we can perform a procedure called portal vein embolization. What this is, is that the patient is taken to radiology and under x-ray vision, we can place a catheter in the liver and block the blood supply off to that side of the liver where the tumor is located. This will cause the other side of the liver to grow before the operation. Typically, the procedure is done as an outpatient procedure. And we obtain repeat x-rays, roughly four to six weeks after the portal vein embolization. If the liver has grown, then we can procede with surgery at that time.
There's many different types of liver resections. Some liver resections can be quite small if the lesion is located near the end of the liver or the side of the liver. Other liver operations can be quite large, where we can remove half of the liver or even rds of the liver. The extent of the liver operation is dictated based on the size and the location of the tumors within the liver. Occasionally, we can perform the operation using a minimally invasive approach. This has benefits because there's less pain associated with it, and patients can frequently go home earlier. Many patients however, who have more extensive disease however, will need to undergo the more traditional open approach. Depending on the extent of the liver operation, the time for the operation will differ. Typically, however, most liver operations will take anywhere from two to five hours.
What a patient can expect when facing liver surgery is that typically they come in to the day of sur, come into the hospital the day of surgery, undergo their operation. Most patients here at Hopkins will spend one night in the intensive care unit and the next day be discharged to the floor. The typical hospital stay is anywhere from about three to five days, following that the patient goes home. And when the patient goes home, they're able to do all the normal activities of daily living, their eating, their walking, they're able to do stairs. Some patients will experience some fatigue which may last a couple weeks, but in general, patients do very well after this type of operation.
There's been great technical advances in liver resection over the last number of years. This is a very safe procedure. The risks that are associated with the liver resection would include infection, bleeding or a bile leak. The liver makes bile. So when we cut through the liver, there's always a chance the bile could leak out of the cut side. But all of these complications are fairly low in the range of less then or %. In fact the overwhelming majority of patients who undergo liver resection here at Johns Hopkins will require no blood transfusion at the time of the operation.
The liver does grow back after resection. But the liver is actually fairly smart, and only needs to grow back if it needs to. So in other words, if only a small portion of the liver was removed, in general, the liver will not grow back. However, if we remove a significant portion of the liver, then the liver indeed will grow back. I think Hopkins is a, a very special place. In particular, when we're talking about patients who have liver tumors, most of these patients have very complex problems and require a multidisciplinary approach. That will not only require surgery, but also medical oncology, interventional radiology, hepatology, radiology and radiation oncology. Patients who have these tumors also have very technically demanding operations.
And it's important for patients to be seen at high volume centers with a significant amount of expertise. Hopkins has this expertise, but we also have a caring team that really sees individuals not as patients but as people, and we're able to bring to bear all of the therapies necessary to get people healthy again.
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