Hepatocellular Carcinoma In Segment Research Articles

Efficacy and safety of laparoscopic liver resection for hepatocellular carcinoma in segment 8: a propensity score-matched two-center study.

The safety and efficacy of laparoscopic liver resection (LLR) have been reported worldwide. However, those of LLR for tumors located in Couinaud's segment 8 are not sufficiently investigated. We retrospectively analyzed 108 patients who underwent liver resection for hepatocellular carcinoma (HCC) in segment 8 at Kobe University Hospital and Hyogo Cancer Center between January 2010 and December 2021. The patients were categorized in LLR and open liver resection (OLR) groups, and 1:1 propensity score matching (PSM) was performed to compare surgical outcomes between the groups. Forty-seven and 61 patients underwent LLR and OLR, respectively. After PSM, each group contained 34 patients. There was no significant difference in operation time between the groups (331min vs. 330min, P = 0.844). Patients in the LLR group had significantly less blood loss (30mL vs. 468mL, P < 0.001) and shorter length of postoperative hospital stay (10days vs. 12days, P = 0.015) than those in the OLR group. There was no significant difference in the occurrence of postoperative complications between the groups (12% vs. 9%, P = 0.690). Further, the 1-year cumulative incidence of recurrence was not significantly different between the groups (16% vs. 19%, P = 0.734). The surgical outcomes and short-term prognosis of LLR were similar or better than those of OLR. LLR could be an effective and safe procedure, even for lesions located in segment 8, which is considered a difficult anatomical location for LLR.

Open right hepatectomy post tace in a patient of hepatocellular carcinoma in segment 6 and 7 with aberrant right sectoral duct in common hepatic duct

Open right hepatectomy post tace in a patient of hepatocellular carcinoma in segment 6 and 7 with aberrant right sectoral duct in common hepatic duct

Diaphragmatic hernia after radiofrequency ablation of liver metastases: a case report and review of the literature.

A diaphragmatic hernia is the protrusion of abdominal tissues into the thoracic cavity secondary to a defect in the diaphragm. Reviewing the literature, we found only 44 references to diaphragmatic hernia secondary to percutaneous radiofrequency treatment. The vast majority of these cases were secondary to the treatment of hepatocellular carcinoma in segments V and VIII. Nevertheless, to date, this is the first reported case of diaphragmatic hernia after radiofrequency ablation of a liver metastasis from colorectal cancer. Complications secondary to diaphragmatic hernias are very diverse. The principal risk factor for complications is the contents of the hernia; when small bowel or colon segments protrude in the thoracic cavity, they can become incarcerated. Asymptomatic cases have also been reported in which the diaphragmatic hernia was discovered during follow-up. The pathophysiological mechanism is not totally clear, but it is thought that these diaphragmatic hernias might be caused by locoregional thermal damage. Given that most communications correspond to asymptomatic and/or treated cases, it is likely that the incidence is underestimated. However, due to the advent of percutaneous treatments, this complication might be reported more often in the future. Most cases are treated with primary herniorrhaphy, done with a laparoscopic or open approach at the surgeon's discretion; no evidence supports the use of one approach over the other. Nevertheless, it seems clear that surgery is the only definitive treatment, as well as the treatment of choice if complications develop. However, in asymptomatic patients in whom a diaphragmatic hernia is discovered in follow-up imaging studies, management should probably be guided by the patient's overall condition, taking into account the potential risks of complications (contents, diameter of the opening into the thoracic cavity …).

Hernia diafragmática tras radiofrecuencia de metástasis hepática. Reporte de caso clínico y revisión de la literatura

A diaphragmatic hernia is the protrusion of abdominal tissues into the thoracic cavity secondary to a defect in the diaphragm. Reviewing the literature, we found only 44 references to diaphragmatic hernia secondary to percutaneous radiofrequency treatment. The vast majority of these cases were secondary to the treatment of hepatocellular carcinoma in segments V and VIII. Nevertheless, to date, this is the first reported case of diaphragmatic hernia after radiofrequency ablation of a liver metastasis from colorectal cancer. Complications secondary to diaphragmatic hernias are very diverse. The principal risk factor for complications is the contents of the hernia; when small bowel or colon segments protrude in the thoracic cavity, they can become incarcerated. Asymptomatic cases have also been reported in which the diaphragmatic hernia was discovered during follow-up. The pathophysiological mechanism is not totally clear, but it is thought that these diaphragmatic hernias might be caused by locoregional thermal damage. Given that most communications correspond to asymptomatic and/or treated cases, it is likely that the incidence is underestimated. However, due to the advent of percutaneous treatments, this complication might be reported more often in the future. Most cases are treated with primary herniorrhaphy, done with a laparoscopic or open approach at the surgeon's discretion; no evidence supports the use of one approach over the other. Nevertheless, it seems clear that surgery is the only definitive treatment, as well as the treatment of choice if complications develop. However, in asymptomatic patients in whom a diaphragmatic hernia is discovered in follow-up imaging studies, management should probably be guided by the patient's overall condition, taking into account the potential risks of complications (contents, diameter of the opening into the thoracic cavity …).

Major vessel bleeding control experience in laparocopic major hepatectomy

Laparoscopic hepatectomy (LH) is worldwidely spread, because LH needs small incision which cause less pain. But during LH, it is hard to control major bleeding. Patient could be in dangerous situation. So we will propose some tips to make control major bleeding during LH. The first case had 2.5 cm hepatocellular carcinoma in segment 5/6. We planned to laparoscopic right hemihepatectomy. After surgery, he had no special event. And he had discharge, at pod 6. The second case underwent low anterior resection due to rectosigmoid colon cancer 6 years ago. He had 3 cm metastatic colon cancer in liver. We planned to laparoscopic right hemihepatectomy. during surgery, uncontrolled massive bleeding happened, he arrested. So open conversion was done. And he had discharge, at pod 5. In the first case, there was bleeding during ligation of vessel by hemoloc. We couldn't recognized bleeding focus. So more liver parenchymal dissection was done. We found that inferior vena cava (IVC) which is base of right hepatic vein (RHV) inferior wall was laceration. The operative used laparoscopic surgical stapler for division of RHV and bleeding control. In the second case, liver parenchyma was dissection fully and ready to division the RHV. Operator dissect posterior wall of RHV by golden finger and dissector. At this moment, IVC which is base of RHV was laceration. operator tried to control bleeding by suture IVC. But the patient arrested. Open conversion operator was done. We suggest laparoscopic surgical stapler rather than manual suture, during massive bleeding.

Redo laparoscopic segment 2/3 hepatocellular carcinoma resection in alcohol-related chronic liver disease

Purpose: Hepatocellular Carcinoma is a leading cause of death in chronic liver disease and cirrhosis. Operative treatment options include surgical resection or liver transplantation. Minimally invasive approaches reduce patient morbidity and improve recovery and return to normal activity, but can be an operative challenge in fibrotic, cirrhotic liver parenchyma. Method: 72-year-old male presented with Hepatocellular Carcinoma in segment 2/3 on a background of alcohol-related Chronic Liver Disease. Multidisciplinary decision to proceed to Laparoscopic Non-anatomical Liver resection. Histology demonstrated mixed HCC, R0 resection with microvascular invasion present. 8/12 follow updemonstrated recurrence in left lateral segments 2/3. Multidisciplinary decision to proceed to Laparoscopic redo Liver resection of segment 2/3 Results: Laparoscopic non-anatomical resection of Segment 2/3 HCC was performed. Histology demonstrated HCC, R0 resection. The patient made an uncomplicated recovery and remains disease free at 4 years. Conclusion: Laparoscopic re-do liver resection for HCC with background chronic liver disease is a feasible and safe approach in selected cases. Careful haemostasis during laparoscopic dissection in cirrhosis is key to avoid intraoperative bleeding, and minimise the risk of losing the visual field and converting to open surgery.

Laparoscopic liver resection with an 80-degree articulating advanced bipolar device

The video shows the case of a 68-year-old male patient, affected by hemochromatosis, with 3-cm hepatocellular carcinoma in segment 5 on cirrhotic liver. The patient was classified as Child A5, MELD 7, with portal hypertension. An ultrasound-guided laparoscopic resection of segment 5 was planned. Liver resection was carried out by the 80-degree articulating vessel sealer (Aesculap Caiman; B. Braun, Tuttlingen, Germany). The embedded video shows how this device is safe and efficient for laparoscopic liver resection and how its 80-degree articulation jaw may be useful in case of deep or posterior transection planes in order to obtain an adequate oncologic surgical margin.

Portal vein aneurysm associated with arterioportal fistula after hepatic anterior segmentectomy: Thought-provoking complication after hepatectomy

BackgroundFew cases of postoperative arterioportal fistula (APF) have been documented. APF after hepatectomy is a very rare surgery-related complication.Case presentationA 62-year-old man was diagnosed with hepatocellular carcinoma in segments 5 and 8, respectively. Anterior segmentectomy was performed as a curative surgery. Each branch of the hepatic artery, portal vein, and biliary duct for the anterior segment was ligated together as the Glissonean bundle. The patient was discharged on postoperative day 14. Three months later, dynamic magnetic resonance imaging showed an arterioportal fistula and portal vein aneurysm. Surprisingly, the patient did not have subtle symptoms. Although a perfect angiographic evaluation could not be ensured, we performed angiography with subsequent interventional radiology to avoid sudden rupture. Arteriography was immediately performed to create a portogram via the APF from the stump of the anterior hepatic artery, and portography clearly revealed hepatofugal portal vein flow. Portography also showed that the stump of the anterior portal vein had developed a 40-mm-diameter portal vein aneurysm. Selective embolization of the anterior hepatic artery was accomplished in the whole length of the stump of the anterior hepatic artery, and abnormal blood flow through the APF was drastically reduced. The portal vein aneurysm disappeared, and portal flow was normalized. Dynamic computed tomography after embolization clearly demonstrated perfect interruption of the APF. The patient maintained good health thereafter.ConclusionsPost-hepatectomy APFs are very rare, and some appear to be cryptogenic. Our thought-provoking case may help to provide a possible explanation of the causes of post-hepatectomy APF.

Fusion anomaly of the pancreatic tail and spleen: a case report

BackgroundSplenopancreatic fusion is a rare anomaly that is often associated with trisomy 13. Its diagnosis can be important in patients scheduled to undergo distal pancreatectomy or splenectomy, to avoid possible intraoperative or postoperative complications.Case presentationAn 82-year-old Japanese man was referred to our hospital for further evaluation and treatment for a solitary hepatocellular carcinoma based on liver cirrhosis. Triple-phase contrast-enhanced multidetector-row computed tomography and magnetic resonance imaging showed a splenopancreatic fusion as well as a solitary hepatocellular carcinoma in segment VIII of his liver.ConclusionsFusion of the pancreatic tail and spleen is a rare and asymptomatic anomaly. Its detection can be improved by the use of multidetector computed tomography or magnetic resonance imaging.

Agenesis of the left hepatic lobe undergoing laparoscopic hepatectomy for hepatocellular carcinoma: a case report

BackgroundAgenesis of the left hepatic lobe is a rare anomaly. It is defined as the absence of liver tissue to the left of the gallbladder fossa. Additionally, agenesis of the left hepatic lobe accompanied by hepatocellular carcinoma is quite rare. We experienced the case of a patient with agenesis of the left hepatic lobe, undergoing laparoscopic hepatectomy for HCC.Case presentationA 79-year-old man was referred to our department with epigastralgia. Abdominal computed tomography revealed agenesis of the left hepatic lobe, accompanied by hepatocellular carcinoma in segments 7 and 8. He underwent laparoscopic partial hepatectomy of segments 7 and 8. The operative findings revealed complete agenesis of the liver to the left of the falciform ligament. The patient had a favorable clinical course without liver dysfunction or any complications.ConclusionsWe experienced a case with agenesis of the left hepatic lobe undergoing laparoscopic hepatectomy for HCC. Awareness of such anomaly is important for surgeons to avoid postoperative complications.

Laparoscopic Repair of Diaphragmatic Perforation with Colonic Herniation Following Hepatic Radiofrequency Ablation: A Case Report

Background: Diaphragmatic hernia is a rare complication after hepatic radiofrequency ablation (RFA). We herein present a case of a patient who underwent laparoscopic repair of diaphragmatic perforation with colonic herniation occurring 12 months after hepatic RFA. Case presentation: An 80-year-old man underwent RFA under computed tomography guidance using a cool-tip radiofrequency probe with a short trans-thoracic root for hepatocellular carcinoma in segment VIII. Twelve months later, he developed a large amount of right pleural effusion and a right diaphragmatic hernia containing the colon and mesentery. After drainage of the right pleural effusion, the patient underwent laparoscopic repair of the diaphragmatic perforation with colonic herniation. Severe adhesion was noted between nearly the entire herniated colon and lung; however, we were able to remove the herniated colon from the thoracic cavity safely. Bowel resection was not required. Finally, simple running sutures of the diaphragmatic defect using 2-0 Vicryl were laid down. There were no postoperative complications, and the patient was discharged nine days after surgery. Conclusions: Diaphragmatic hernia is rare but should be recognized as a late complication following hepatic RFA. Surgical repair of a diaphragmatic hernia, including minimally invasive surgery using the laparoscopic approach, especially for patients with cirrhosis, should be considered in order to avoid acute intestinal obstruction or perforation.

Real-time image guidance in laparoscopic liver surgery: first clinical experience with a guidance system based on intraoperative CT imaging

Laparoscopic liver surgery is particularly challenging owing to restricted access, risk of bleeding, and lack of haptic feedback. Navigation systems have the potential to improve information on the exact position of intrahepatic tumors, and thus facilitate oncological resection. This study aims to evaluate the feasibility of a commercially available augmented reality (AR) guidance system employing intraoperative robotic C-arm cone-beam computed tomography (CBCT) for laparoscopic liver surgery. A human liver-like phantom with 16 target fiducials was used to evaluate the Syngo iPilot(®) AR system. Subsequently, the system was used for the laparoscopic resection of a hepatocellular carcinoma in segment 7 of a 50-year-old male patient. In the phantom experiment, the AR system showed a mean target registration error of 0.96 ± 0.52 mm, with a maximum error of 2.49 mm. The patient successfully underwent the operation and showed no postoperative complications. The use of intraoperative CBCT and AR for laparoscopic liver resection is feasible and could be considered an option for future liver surgery in complex cases.

Endoscopic ultrasonography‐guided transgastric drainage of infectious biloma following radiofrequency ablation for hepatocellular carcinoma

An 87-year-old woman was diagnosed with a 22-mm diameter hepatocellular carcinoma in segment II and treated by percutaneous ultrasound-guided radiofrequency ablation (RFA). Six months later, she presented to the emergency room complaining of high fever and general malaise. Computed tomography (CT) images showed a 96 ¥ 60-mm fluid collection in the left lobe of the liver (Fig. 1). She was diagnosed with sepsis due to biloma infection caused by RFAmediated bile duct disruption. Because the biloma was adjacent to the stomach, we carried out endoscopic ultrasonography (EUS)-guided transgastric drainage of the biloma. A discharge of pus was observed following the creation of internal and external fistulas between the biloma and stomach using a 7-Fr double-pigtail stent and a 7.5-Fr singlepigtail tube (Fig. 2) and cultures of the purulent fluid grew Escherichia coli. A CT scan obtained 4 weeks after drainage confirmed complete resolution of the biloma and the patient recovered uneventfully. Although biloma formation related to bile duct disruption is a frequent complication of RFA, biloma infection complicated with bacteremia is very rare. Bilomas are usually treated by either percutaneous drainage or surgery. This patient, however, was very elderly and had advanced dementia, so it was difficult for her to keep still during percutaneous puncture. In addition, the risk for self-removal of the drainage tube was considered to be high. The utility of EUSguided drainage of intra-abdominal fluid collections is well documented, whereas there have been a small number of reports on EUS-guided drainage of bilomas. The biloma in this patient was located adjacent to the stomach; therefore, EUS-guided drainage was considered to be a promising alternative and was successfully carried out. In summary, the risk of biloma infection should be considered, especially in putative immune-compromised older patients. Moreover, careful attention must be paid to the possibility of delayed biloma infection even 6 months after RFA.

Anatomical liver segmentectomy 2 for combined hepatocellular carcinoma and cholangiocarcinoma with tumor thrombus in segment 2 portal branch

BackgroundHepatic resection is the only effective treatment for combined hepatocellular carcinoma and cholangiocarcinoma.Case presentationA 52-year-old man was preoperatively diagnosed with hepatocellular carcinoma in segment 2 with tumor thrombus in the segment 2 portal branch. Anatomical liver segmentectomy 2, including separation of the hepatic arteries, portal veins, and bile duct, enabled us to remove the tumor and portal thrombus completely. Modified selective hepatic vascular exclusion, which combines extrahepatic control of the left and middle hepatic veins with occlusion of left hemihepatic inflow, was used to reduce blood loss. A pathological examination revealed combined hepatocellular carcinoma and cholangiocarcinoma with tumor thrombus in the segment 2 portal branch. No postoperative liver failure occurred, and remnant liver function was adequate.ConclusionThe separation method of the hepatic arteries, portal veins, and bile duct is safe and feasible for a liver cancer patient with portal vein tumor thrombus. Modified selective hepatic vascular exclusion was useful to control bleeding during liver transection. Anatomical liver segmentectomy 2 using these procedures should be considered for a patient with a liver tumor located at segment 2 arising from a damaged liver.

Video-assisted thoracoscopic transdiaphragmatic liver resection for hepatocellular carcinoma

Because of technical complexity, concern for vascular control, and uncertainty in regard to oncologic outcome, the application of minimally invasive techniques to liver surgery has been slower than in most other abdominal procedures. This is despite well-known advantages with respect to postoperative pain, length of hospitalization, and recovery time. Although laparoscopic liver surgery has recently become more common, the majority of laparoscopic liver resections comprise anterolateral wedge resections and left lateral sectorectomies. Laparoscopic resections of the posterosuperior segments are more difficult and few reports are available in the literature. Compared to laparoscopy, gaining access to tumors in the dome of the liver may be more easily obtained via thoracoscopy, thereby preserving the benefits of minimally invasive surgery. This technical report describes two cases of hepatocellular carcinoma in segments VII and VIII resected via a video-assisted thoracoscopic transdiaphragmatic approach.

Carcinome hépatocellulaire de petite taille révélé par un prurigo

Paraneoplastic cutaneous manifestations associated with hepatocellular carcinoma may allow early diagnosis and curative treatment. Chronic prurigo alone may reveal hepatocellular carcinoma hepatocellular carcinoma in the absence of any other abnormal laboratory results potentially indicative of hepatic disease. A 79-year-old woman was referred to our unit for prurigo beginning 3 months earlier, occurring night and day and causing insomnia. The initial results were completely normal. In the absence of improvement under treatment with dermal corticosteroids, additional investigations were performed, in particular, abdominal ultrasound. The latter showed a liver nodule of 1.5 cm in diameter. CT scan confirmed the presence of this nodule and revealed morphological changes consistent with hepatocellular carcinoma in segment VIII. Alpha-fetoprotein was elevated. Following surgical treatment of this hepatocellular carcinoma, skin lesions regressed without any further treatment. One year later, no relapse of skin lesions was observed and the patient was in complete remission regarding hepatocellular carcinoma. Prurigo may constitute a paraneoplastic sign of hepatocarcinoma, the prognosis of which depends upon the stage at which it is discovered. For small tumors (< 3 cm), surgery may be curative. Of the few cases reported in the literature, our patient is the first to undergo curative surgery thanks to early diagnosis.

A Case of Hepatocellular Carcinoma with Situs Inversus Totalis

We report a case of hepatocellular carcinoma with situs inversus totalis treated by hepatectomy. A 70-year-old asymptomatic female with hepatocellular carcinomas in segments 5, 6 and 8 underwent transarterial embolization in the department of medicine. However, hepatocellular carcinoma in segment 8 relapsed, and she was referred to the department of surgery. Laboratory tests revealed elevation of serum PIVKA2 level (4,690 ng/mL). Angiography revealed tumor stain in segment 8, 3 cm in diameter. No aberrant vessels were detected on angiography. The operator stood on the patient's left, and partial hepatectomy could be performed safety after careful examination of the anatomy. Although aberrant vessels are detected in many patients with situs inversus totalis, operations can be performed safely on them with sufficient understanding of the anatomy.