Journal: Annals of surgical oncology
This publication reports a single complex case of laparoscopic anatomical liver resection for centrally located hepatocellular carcinoma in a cirrhotic patient.
A 40-year-old man with cirrhosis had a tumor involving segments 4, 5, 8 and partially the ventral subsegment of segment 3 (S3v). Standard extended left hepatectomy would have left an inadequate future liver remnant (28.2%), so the team planned a parenchyma-sparing anatomical resection of S4/S5/S8 plus S3v.
Key technical elements:
- Preoperative three-dimensional modeling to define tumor extent and plan a tailored anatomical resection.
- Umbilical fissure approach to sequentially transect the Glisson pedicles of segment 4 and S3v, creating an ischemic demarcation line for the left resection margin.
- Intraoperative indocyanine green (ICG) negative staining after blocking the right anterior Glisson pedicle to clearly delineate the boundary between the right anterior and posterior sectors.
- Parenchymal transection under ICG fluorescence guidance, with full exposure of the right hepatic vein trunk at completion.
Operative outcomes:
- Operative time: 270 minutes.
- Blood loss: 50 mL.
- Histopathology: moderately to poorly differentiated hepatocellular carcinoma with negative margins.
- Postoperative course: discharged on day 8 without complications.
The authors conclude that laparoscopic anatomical central hepatectomy combined with (sub)segmental left lobe resection, guided by umbilical fissure approach and ICG fluorescence, is feasible for selected, centrally located hepatocellular carcinomas and can achieve radical resection while preserving more functional liver parenchyma than an extended left hepatectomy.