Glisson pedicle ligation for unresectable hepatocellular carcinoma

Abstract

Abstract Introduction: Hepatocellular carcinoma (HCC) is 1 of the most common malignant neoplasms worldwide. Surgical resection is the first choice of treatment. However, surgical resection is unsuitable for certain types of HCC. Patient concerns: A 47-years-old male patient presented with Child-Pugh class A liver function and the indocyanine green retention rate at 15 min effectively was 3.5%. Computed tomography and magnetic resonance imaging indicated that the tumors were distributed in the anterior segment of right lobe, and near the hepatic portal area. The maximum size of the tumor was approximately 86mm×82 mm. Diagnosis: The patient was diagnosed with hepatocellular carcinoma Stage IIIB. After pre-operative evaluation, hepatic segmentectomy by Glisson pedicle approach was recommended. Interventions: Hepatic segmentectomy by Glisson pedicle approach was recommended. But there was heavy bleeding during hepatic resection after the ligation of the Glisson pedicle on the right anterior branches. Hence only Glisson pedicle ligation was performed without hepatic segmentectomy. Outcomes: During 1 year of postoperative follow-up, the patient had no obvious complications. The computed tomography and magnetic resonance imaging indicated significant reduction in the size of tumor. The tumor was observed to have undergone liquefaction necrosis after 6 months. The serum a-fetoprotein also decreased significantly. Conclusion: The Glisson pedicle ligation may be an optional treatment in selected cases of unresectable HCC. However, further research is needed to understand the effectiveness of this treatment.