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Partial liver lobectomy refers to the surgical removal of part of a liver lobe in the dog. This is most commonly performed to remove a large, solitary tumor located in the liver or to obtain a sample of liver for analysis.
Liver lobectomy does carry risk, but when the right patients are selected (those with only one tumor) and any pre-existing problems (such as blood clotting disorders) are corrected, the benefits in terms of extended life expectancy are considerable.
Partial lobectomy may be performed in first opinion practices if the liver lesion is small and restricted to the outer part of a liver lobe. However, the majority of large liver masses require referral to a specialist veterinary surgeon.
The patient requires a thorough work up prior to surgery. This enables the surgeon to plan the approach to the liver, and check that lobectomy is appropriate. For example, if imaging revealed the presence of multiple tumors or spread to the lungs, then it would not be fair to put the dog through major surgery.
Other screening tests include bloods to check if the patient is anemic (a blood transfusion may be required to stabilize them) and the dog's blood clots normally.
The patient is given a pre-med injection containing sedatives and pain relief, and put onto intravenous fluids. Lobectomy requires a full general anesthetic which is closely monitored by a veterinary anesthetist during the procedure.
The surgeon gains access to the liver via a midline incision in the dog's abdomen. All of the dog's internal organs are checked for signs of cancer. If all is well, the affected liver lobe is then isolated. The major blood vessels to the lobe are tied off to prevent blood loss, and a surgical stapling device used to remove the lobe well below the tumor.
Once the surgeon is happy there is no bleeding from the liver, they close the abdomen, the dog is brought round from the anesthetic and transferred to intensive care.
Partial liver lobectomy is arguably amongst the most satisfying of major surgeries to perform. Although there are risks, of which the biggest is blood loss, when successful the operation can dramatically extend life the patient's life from weeks or months to years.
Many dogs don't show symptoms until their liver tumor is a considerable size. These large tumors are prone to bleeding, and without surgery there is a real risk of sudden death. However, surgery gives those dogs a fighting chance, and if histology of the lump comes back as benign (not liable to spread) in many cases the operation is curative.
Removing part of a vascular organ such as the liver is major surgery. The patient should be closely monitored in the immediate hours and days after the operation, so their pain can be managed and any signs of internal bleeding spotted early.
The latter involves taking small samples of blood at regular intervals in order to analyze if any internal loss is occurring.
After two or three days the risk of hemorrhage reduces, and most dogs are able to return home to be cared for by their owner. The sutures are removed from the skin incision around 10 to 14 days post surgery. During those two weeks, it is important the dog is rested and does not exert themselves in any way.
The cost of surgery is liable to be several thousand dollars, with additional fees incurred for the diagnostic workup.
For example, the cost of an ultrasound exam varies from $50 to $450 depending on the experience of the operator. A CT scan (around $1,000) or MRI scan ($1,800) may also be required to allow proper surgical planning. Should a blood transfusion be necessary, this will add around $500 for per unit. Some dogs require 2 units a day, with obvious multiplication of the costs.
Without surgery, a patient with a large liver tumor is unlikely to survive more than a few months at best. With surgery, there is a chance (depending on the type of tumor) the cancer could be completely removed. Overall, in the right hands the survival rate for partial liver lobectomy is an impressive 95.2%.
Most liver tumors occur spontaneously and therefore there is no tangible way of preventing them from developing. On the other hand, one of the rare reasons for partial lobectomy - trauma- is often preventable. The commonest cause of trauma in the dog is a road traffic collision. Simple precautions such as keeping the dog on a leash beside busy roads, making sure the yard is secure, and training a solid recall will all help remove the need for emergency surgery such as a lobectomy.
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