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Liver lobectomy refers to the surgical removal of an entire liver lobe in the cat. The most common reason for lobectomy is the presence of a tumor within the liver lobe.
Lobectomy is demanding surgery, not least because cats with liver disease are associated with a high risk of blood clotting disorders. Indeed, the main hazard linked with this surgery is blood loss, and owners should expect their cat to need intensive care nursing for several days after this procedure.
The patient needs careful assessment so surgery is only performed when it's likely to increase the cat's life expectancy. This will include screening blood tests (to check for other organ failure, and coagulation factors), x-rays (seeking secondary spread to the lungs) CT or MRI scans (to assess the extent of the tumor and if it is solitary or multiple), and ultrasound guided liver biopsy (to check for malignancy.)
Those cases selected for lobectomy are given a full general anesthetic, and carefully monitored whilst asleep. They are likely to receive ongoing pain relief and intravenous fluids. The surgeon has a choice of techniques to remove the liver lobe. These include blunt dissection, self-ligating loops, or stapling devices. Ultimately, the choice depends on the size and location of the mass and the surgeon's personal preference.
Once the lobe is removed, the surgeon checks there is no bleeding, and then closes the abdomen. The patient is transferred to intensive care where they are closely monitored to blood loss or signs of shock.
Unfortunately, cats are more prone to malignant (cancer that spreads) tumors than benign. Indeed, even if the cat survives the procedure, those with malignant tumors have a very poor long-term outlook and are likely to die shortly after surgery.
Those cats with benign tumors that are successfully removed in their entirety have a good outlook, with some living for years afterwards. However, it should be remembered that since many cats with disease involving the liver also have clotting disorders, there is a significant risk of hemorrhage during surgery or in the immediate postoperative period.
The anatomy of the liver means that it is intimately linked to major blood vessels such as the vena cava, which carries blood into the heart. In addition, the liver is a very vascular organ, with some of those blood vessels having delicate walls which are easily damaged, leading to blood loss. This can occur at any time during or immediately after the operation.
Once the surgeon is satisfied there are no bleeds, the cat wakes and is taken to intensive care. Regular observations are taken, and blood samples taken to check for internal hemorrhage. The cat will also be given pain relief.
If all goes well the cat leaves ICU after 36 to 48 hours, and once eating unsupported is able to go home. The cat must rest for 14 days, including no running, jumping, or vigorous play. Skin sutures are removed after 10 to 14 days, at which point the cat can return to normal.
The cost of a liver lobectomy runs into thousands of dollars, rather than the hundreds. In part, this is due to the complexity of the surgery, and in part to the monitoring needed in the postoperative period.
Considerable cost is also involved in the presurgical assessment. This involves both screening blood tests ($50 - $140) and diagnostic liver tests ($100), radiography ($50 - $250) and a CT scan ($1,200).
The surgery to remove a liver lobe carries significant risk, and so it's critical the patient is carefully assessed before going ahead. This enables the surgeon and owner to have an honest discussion about the benefit of surgery to the patient, balanced against the long-term outlook.
When carefully selected, some cats can live on for many years and eventually die of a problem unrelated to their liver tumor. However, this is balanced against the risk of hemorrhage around the time of surgery, and the poor outlook for cats that have malignant liver tumors.
Liver tumors can arise as a primary cancer (a tumor that originates in the liver) or a secondary (the liver is a common site for cancer to spread to.) The aim of screening prior to surgery is to identify those cats that have a poor long-term outlook and hence avoid the stress to them of surgery which is not beneficial in the long run.
Unfortunately, there is at present no known strategy for preventing liver cancer as it is just 'one of those things' that develops for no known reason. This means an owner should not feel guilty if their cat develops liver cancer, it is not of their making, and it’s likely nothing they could have done differently would have prevented it.
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