Osamu Itano, MD, PhD, FACS, Ryusuke Amemiya, MD, Masahiro Shinoda, MD, PhD, Minoru KItago, MD, PhD, Yuta Abe, MD, PhD, Taizo Hibi, MD, PhD, Hiroshi Yagi, MD, PhD, Yuko Kitagawa, MD, PhD, FACS. Department of Surgery, keio University School of Medicine
Introduction: Laparoscopic hepatectomy for hepatocellular carcinoma (HCC) has been increasingly adopted and recently performed for the recurrent tumors even with advanced portal vein tumor thrombus. We recently performed pure laparoscopic resection of residual left lobe and thrombectomy for recurrent HCC located in segment 4 with tumor thrombus in the left hepatic duct after open left lateral hepatectomy.
Patients and Methods: The patient in the video was a 54-year-old man of chronic hepatitis B who was diagnosed as recurrent HCC located in segment 4 with tumor thrombus in the left hepatic duct after open left lateral hepatectomy. At first, dissection of severe intraperitoneal adhesion due to the previous surgery was performed with scissors. After cholecystectomy, the common bile duct was isolated and taped. The left hepatic artery and left branch of the portal vein were divided individually. Mobilization of the residual left lobe and the Spiegel’s lobe was performed. Before dissecting the left hepatic duct, liver parenchymal transection was completed along the demarcation line, exposuring middle hepatic vein to the cut surface of the liver. The left hepatic vein was ligated, clipped and dissected. Finally, the left hepatic duct was dissected with scissors, checking the position of tumor thrombus in the left hepatic duct after identification of tumor thrombus with ultrasonography. Complete thrombectomy was confirmed and the stump of the left hepatic duct was closed by suturing under laparoscopy.
Results: The operation time was 380 min, and the blood loss was 200ml. The postoperative hospital stay was 6 days, and there was no postoperative morbidity and mortality. The patient survived for 20 months after curative resection without tumor recurrence.
Conclusions: Laparoscopic hepatectomy and thrombectomy for recurrent HCC with tumor thrombus in the left hepatic duct was safely performed. This procedure is a safe and feasible when performed in selected patients by surgeons with expertise in hepatic surgery and minimally invasive techniques.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78993
Program Number: V153
Presentation Session: Solid Organ Video Session
Presentation Type: Video