Repeat laparoscopic anatomical liver resection in a hepatocellular carcinoma patient: a case report

Abstract

Anatomical resection (AR) has been reported to achieve better long-term outcomes than non-anatomical resection for the treatment of hepatocellular carcinoma (HCC). The surgical feasibility and oncological significance of laparoscopic AR (LAR), especially “subsegment resection”, “cone unit resection”, and repeat LAR for HCC, remain unproven. We present a 67-year-old patient with alcoholic liver cirrhosis and HCC who underwent full LAR three times, focusing on the technical aspects of the Glissonean approach. Repeating LAR for recurrent HCC could be a safe and feasible procedure. However, HCC recurred in the neighboring segment twice, even though pathological vascular invasion and marginal remnants were not confirmed. We should investigate the oncological significance and advancements in subsegmentectomy and cone unit resection, in the future.

Keywords

Repeat laparoscopic anatomical liver resection / HCC / Glissonean approach / subsegmentectomy / cone unit resection

References

[1] Hasegawa K,Imamura H.Prognostic impact of anatomic resection for hepatocellular carcinoma.Ann Surg2005;242:252-9 PMCID:PMC1357731

[2] Haruki K,Fujiwara Y.Effectiveness of anatomical resection for small hepatocellular carcinoma: a propensity score-matched analysis of a multi-institutional database.J Gastrointest Surg2021;25:2835-41

[3] Wakabayashi G.What has changed after the Morioka consensus conference 2014 on laparoscopic liver resection?.Hepatobiliary Surg Nutr2016;5:281-9 PMCID:PMC4960417

[4] Kaneko H,Kubota Y.Evolution and revolution of laparoscopic liver resection in Japan.Ann Gastroenterol Surg2017;1:33-43 PMCID:PMC5881311

[5] Takahara T,Konno H.Comparison of laparoscopic major hepatectomy with propensity score matched open cases from the National Clinical Database in Japan.J Hepatobiliary Pancreat Sci2016;23:721-34

[6] Twaij A,Sodergren MH,Darzi A.Laparoscopic vs open approach to resection of hepatocellular carcinoma in patients with known cirrhosis: systematic review and meta-analysis.World J Gastroenterol2014;20:8274-81 PMCID:PMC4081703

[7] Cherqui D,Tayar C.Laparoscopic liver resection for peripheral hepatocellular carcinoma in patients with chronic liver disease: midterm results and perspectives.Ann Surg2006;243:499-506 PMCID:PMC1448957

[8] Imura S,Saito Y,Morine Y.Utility of cone unit liver resection for small hepatocellular carcinoma: a propensity score matched analysis.HPB (Oxford)2021;23:739-45

[9] Berardi G,Li CJ.Parenchymal sparing anatomical liver resections with full laparoscopic approach: description of technique and short-term results.Ann Surg2021;273:785-91

[10] Takahara T,Beppu T.Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study.J Hepatobiliary Pancreat Sci2015;22:721-7

[11] Wakabayashi G.Systematic reviews from the 2nd international consensus conference on laparoscopic liver resection.J Hepatobiliary Pancreat Sci2015;22:325-6

[12] Wang ZY,Sun LL.Laparoscopic versus open major liver resection for hepatocellular carcinoma: systematic review and meta-analysis of comparative cohort studies.BMC Cancer2019;19:1047 PMCID:PMC6833163

[13] Morise Z.Status and perspective of laparoscopic repeat liver resection.World J Hepatol2018;10:479-84 PMCID:PMC6068843

[14] Onoe T,Irei T.Feasibility and efficacy of repeat laparoscopic liver resection for recurrent hepatocellular carcinoma.Surg Endosc2020;34:4574-81

[15] Wakabayashi T,Memeo R.Short-term outcomes of laparoscopic repeat liver resection after open liver resection: a systematic review.Surg Endosc2019;33:2083-92