Laparoscopic anatomic liver resection of a large hepatocellular carcinoma located in the postero-superior segments (S8) in a cirrhotic patient

Abstract

Introduction: Minimal invasive anatomic liver resection (MIALS) for hepatocellular carcinoma (HCC) located in the postero-superior segments can be challenging due to the difficult access and the increased risk of bleeding, especially in patients with liver cirrhosis. However special tips and tricks might help to overcome difficulties in performing a proper anatomic resection, ensuring safety and oncological efficiency, in particular when > 1 cm of clear negative margin is believed to be essential. Method: The aim of this video is to present the technical aspects and the feasibility of MIALS of HCC in a cirrhotic patient located in segment VIII. Results: The patient was a male of 66 years old man with a large lesion (55 mm) located in segment VIII. Medical history was characterized by liver cirrhosis (Child-Pugh score A6), diabetes mellitus II, metabolic syndrome, HBV +, mild portal hypertension. We performed a proper segment VIII MIALS with the identification and division of segmental inflow and outflow. The lesion was a 58 mm poor differentiated HCC with a resection margin > 10 mm (R0), without vascular invasion. Satellite nodule (5 mm) was detected next to the lesion within the resection margin (R0); METAVIR score 4. Operative time was 220 min with 150 cc of blood lost. Hospital stay was 4 days with no complications. Conclusion: MIALS for large HCC located in the postero-superior segments in cirrhotic patients is feasible and offer the benefits of laparoscopic surgery. However, clear negative margin > 1 cm appears to be still necessary for the high risk of satellite lesions when considering liver resection for HCC.