Laparoscopic segment V and VI resection with pedicular lymph nodes dissection for intrahepatic cholangiocarcinoma

Abstract

Background: Two international consensus conferences (Louisville and Morioka) followed by one European Southampton consensus guidelines definitely emphasized the benefits of laparoscopic liver resection (LLR) for both benign and malignant tumors, including primary and metastatic diseases. In this video, we present a case of total laparoscopic segment V and VI resection with pedicular lymph node dissection for intrahepatic cholangiocarcinoma. Methods: This video present the case of a 73 yo male patient who was found an incidental liver mass during COPD work-up. Preoperative liver work-up with MRI and PET-CT showed a 26mm liver mass located in segments V-VI with 2 hypermetabolic hepatic pedicle lymph nodes. Biopsy of the liver mass had all the characteristics of an intrahepatic cholangiocarcinoma with no underlying liver disease. Liver function was normal. After discussion of the case in MDT, laparoscopic segment V and VI resection with pedicular lymph nodes dissection was decided. Results: Surgery was uneventful. Operative time was 120 minutes and blood loss 300ml. Liver transection was performed under 2 intermittent clamping of 15 minutes. Patient was discharged at POD 3. Analysis of the specimen revealed a 26mm cholangiocarcinoma classified pT2N0R0. Patients was free of disease 6 months after surgery. Conclusion: This case demonstrates that laparoscopic liver surgery for intrahepatic cholangiocarcinoma is safe and feasible with acceptable oncologic outcome.