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Function-preserving segmentectomy of the cirrhotic liver
T Takayama1, T Nakatsuka, K Shimada
1Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
Insights
This study reports a successful surgical treatment for hepatocellular carcinoma (HCC) in a cirrhotic liver with portal vein tumor thrombi. The modified technique preserved liver function after removing the tumor and affected portal vein section.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Liver transplantation
Background:
- Hepatocellular carcinoma (HCC) with portal vein tumor thrombi (PVTT) presents a surgical challenge, especially in cirrhotic livers.
- Standard treatments often have limited efficacy or high risks in such complex cases.
- This report details a novel surgical approach for a challenging HCC presentation.
Observation:
- A patient with severe cirrhosis and HCC involving the right posterior segment and extending into the right portal vein was treated.
- The surgical procedure involved mesentero-umbilical bypass for portal blood shunting, posterior segmentectomy, and anterior portal vein resection.
- Reconstruction of the anterior portal vein was achieved using a patch graft.
Findings:
- The modified hepatic segmentectomy and portal venoplasty were performed without significant complications.
- Pathological examination confirmed a curative resection of the hepatocellular carcinoma.
- The surgical approach aimed at preserving the function of the remaining cirrhotic liver.
Implications:
- This modified surgical technique offers a potential strategy for managing complex HCC with PVTT in cirrhotic patients.
- Functional preservation of the residual liver is a key consideration in optimizing outcomes.
- Further research may explore the broader applicability and long-term results of this approach.
Background/Aims:
A cirrhotic case of hepatocellular carcinoma (HCC) complicating portal vein tumor thrombi which underwent posterior segmentectomy with anterior portal venoplasty is reported.
Materials And Methods:
The HCC originated in the right posterior segment and grew intraluminally up to the right portal vein, and the laboratory data indicated a presence of severe cirrhosis. The operative procedure undertaken consisted of internal shunting of the portal blood stream by mesentero-umbilical bypass, resection of the posterior segment and the anterior portal venous root, and reconstruction of the anterior portal branch by patch grafting.
Results:
This operation produced no distinct complications, and it was defined pathologically as being curative.
Conclusion:
The case here introduces rationale of this modified hepatic segmentectomy in view of functional preservation of the residual cirrhotic liver.