A dorsal transverse hepatectomy for large hepatocellular carcinoma located in liver segment 9 with cava infiltration

Abstract

Background: The resectability of hepatocellular carcinoma (HCC) is multifactorial including the tumor location and the liver function. HCC located in segment 9 is rare and often has signs of inferior vena cava (IVC) infiltration. A combined right trisectionectomy with vascular resection is the choice of treatment that might be contraindicated in patients with limited liver function. Methods: Here we demonstrate in video a new technique for parenchymal sparing resection of large HCC located in segment 9 in patient with limited liver function (minimal fibrosis, 40% macrovesicular steatosis, ICG R15: 18.4%). A dorsal transverse resection of the liver (segments 6,7,9 and 1 ) combined with the partial resection of IVC was performed. Results: There are no signs of liver dysfunction according to 50-50 criteria. Patient was discharged at day 21. There are no signs of tumor recurrence at 6 months after the surgery. Conclusion: This challenging technique preserves maximally the liver parenchyma and increases the resectability of large tumor in liver segment 9, which can be done safely in selected patients.