Case report of the fourth laparoscopic liver resection and review of repeat laparoscopic resection for recurrent hepatocellular carcinoma in cirrhotic liver

Abstract

A 73-year-old woman with liver cirrhosis caused by hepatitis C virus (HCV) underwent treatment of three hepatocellular carcinomas (HCCs) in liver segment 4, following three previous laparoscopic liver resections (LLRs) over 73 months. Contrast-enhanced computed tomography showed three 0.5-1.2 cm HCCs deep within the portal territories of subsegments 4a and 4b. The patient underwent laparoscopic resection of 4a and 4b, with the preservation of the portal branch to 4c, after minimal adhesiolysis around segment 4. The operation lasted 284 min, there was 50 mL of intra-operative bleeding and her recovery was uneventful. She was well, had experienced no recurrence and was HCV-negative, after taking oral anti-HCV therapy, 21 months later. LLR is associated with fewer adhesions after surgery and requires less adhesiolysis, because the laparoscope and forceps can be used in the small spaces between adhesions. The present patient underwent four LLRs over 6 years without severe deterioration of liver functional reserve. LLR is a useful localized therapy, which can be performed repeatedly and may prolong the survival of patients with multicentric metachronous HCCs. Key words:Laparoscopic liver resection, repeat liver resection, hepatocellular carcinoma, liver cirrhosis, anatomical liver resection, subsegmentectomy ABSTRACT Article history:

Caudal Approach to Laparoscopic Liver Resection—Conceptual Benefits for Repeated Multimodal Treatment for Hepatocellular Carcinoma and Extended Right Posterior Sectionectomy in the Left Lateral Position

“…The study showed that LLR is beneficial for patients with Child-Pugh B cirrhosis compared to open procedures ( 22 , 23 ). Furthermore, LLR is speculated to have a benefit of less deterioration of liver function after surgery due to smaller damage related to surgical manipulation mentioned before ( 19 , 24 ), which can lead to long-term benefits during repeated treatment history in HCC/CLD patients.…”

“…Disorientation can easily occur owing to the lack of tactile sensation and the lack of an overview of the entire operative abdominal field. Simulation and navigation from pre- and intra-operative imaging studies and well-planned small anatomical resection to secure tumor localization in the resected area and the tumor-free resected margin are used to overcome this disadvantage ( 24 ).…”

Status and perspective of laparoscopic repeat liver resection

“…The impact of alterations from the previous surgery on hepatic parenchyma and intrahepatic structure could be smaller in such cases. There were three repeat cases with anatomical resection or resections exposing major vessels (including S8 segmentectomy after 4-times LLR[ 40 ]) after previous anatomical resection who developed bile leakage and > 30 d hospital stay, among our 33 repeat and 12 three or more-time repeat LLR cases. Anatomical alterations surrounded by the scars and adhesions on major vessel structures could have big impacts on subsequent anatomical resection or resections exposing major vessels, experiences and evaluations of such setting of repeat LLR are required for the settlement (Table 2 ).…”