Abstract
Background
Laparoscopic liver resection has been increasingly utilized due to its less invasiveness approach compared with open surgery,1,2,–3 but often creates challenges. Hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) portends a poorer prognosis and often precludes patients from potential liver resection.4,5,–6 We herein report a case of laparoscopic hepatectomy and thrombectomy in a patient with HCC and BDTT.
Methods
CT, ERCP, and POCS showed a 40-mm tumor located in the right lobe with BDTT. A five 12-mm trocar was inserted at the umbilicus for laparoscope, the epigastrium, both sides of the hypochondrium, and right lateral region. Moreover, a 5-mm trocar was inserted at left hypochondrium. After cholecystectomy, hepatoduodenal ligament was encircled using the tourniquet through 5-mm trocar site. The right portal vein was transected by stapler following transection of the right hepatic artery. After ICG staining (0.5 mg/body i.v.),7 hepatic parenchymal transection was performed using clamp-crashing technique. Moreover, CUSA also was used near Glissonian sheath. BDTT was removed from the right BD. Moreover, the cholangioscopy confirmed no BDTT remnants. The resection stump was then sutured. Finally, the right hepatic vein was divided with a stapler. A drainage tube was placed in the right subphrenic space. Operation time was 496 min, and blood loss was 91 ml. The patient was discharged without complications on postoperative day 11. Pathological diagnosis showed moderately differentiated HCC, tumor size 40 × 45 mm with negative surgical margins.
Conclusions
Pure laparoscopic resection for HCC with BDTT is a radical, yet feasible procedure.
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References
Memeo R, de’Angelis N, Compagnon P, Salloum C, Cherqui D, Laurent A, Azoulay D. Laparoscopic vs. open liver resection for hepatocellular carcinoma of cirrhotic liver: a case-control study. World J Surg. 2014;38:2919–26.
Ciria R, Gomez-Luque I, Ocaña S, Cipriani F, Halls M, Briceño J, Okuda Y, Troisi R, Rotellar F, Soubrane O, Abu Hilal M. A systematic review and meta-analysis comparing the short- and long-term outcomes for laparoscopic and open liver resections for hepatocellular carcinoma: updated results from the European Guidelines Meeting on Laparoscopic Liver Surgery, Southampton, UK, 2017. Ann Surg Oncol. 2019;26:252–63.
Tozzi F, Berardi G, Vierstraete M, Kasai M, de Carvalho LA, Vivarelli M, Montalti R, Troisi RI. Laparoscopic versus open approach for formal right and left hepatectomy: a propensity score matching analysis. World J Surg. 2018;42:2627–34.
Kasai Y, Hatano E, Seo S, Taura K, Yasuchika K, Uemoto S. Hepatocellular carcinoma with bile duct tumor thrombus: surgical outcomes and the prognostic impact of concomitant major vascular invasion. World J Surg. 2015;39:1485–93.
Orimo T, Kamiyama T, Yokoo H, Wakayama K, Shimada S, Tsuruga Y, Kamachi H, Taketomi A. Hepatectomy for hepatocellular carcinoma with bile duct tumor thrombus, including cases with obstructive jaundice. Ann Surg Oncol. 2016;23:2627–34.
Moon DB, Hwang S, Wang HJ, Yun SS, Kim KS, Lee YJ, Kim KH, Park YK, Xu W, Kim BW, Lee DS, Lee DH, Kim HJ, Lim JH, Choi JS, Park YH, Lee SG. Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus: a Korean multicenter study. World J Surg. 2013;37:443–51.
Nomi T, Hokuto D, Yoshikawa T, Matsuo Y, Sho M. A novel navigation for laparoscopic anatomic liver resection using indocyanine green fluorescence. Ann Surg Oncol. 2018;25:3982.
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Naotake Funamizu, Kohei Mishima, Takahiro Ozaki, Kazuma Nakanishi, Kazuharu Igarashi, Kenji Omura, Yasutsugu Takada, and Go Wakabayashi have no conflict of interest or financial ties to disclose.
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Funamizu, N., Mishima, K., Ozaki, T. et al. Pure Laparoscopic Right Hepatectomy for Hepatocellular Carcinoma with Bile Duct Tumor Thrombus (with Video). Ann Surg Oncol 28, 1511–1512 (2021). https://doi.org/10.1245/s10434-020-09019-y
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DOI: https://doi.org/10.1245/s10434-020-09019-y