Hepatocellular carcinoma is one of the most common cancers
worldwide; hepatic resection is now estabilished as one of
the first-line therapeutic option. Liver resection for hepatocellular
carcinoma must be “radical but conservative” to reduce the
risk of post-operative liver failure. Mesohepatectomy, that
is resection of central hepatic segments (segments 4-5-8),
removes central tumors preserving more functioning liver tissue
than extended left or right hepatectomy.
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Fig. 1 and 2: CT scan showing the tumour involving the central
segments of the liver in close contact with hepatic hilum. |
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Fig. 3: operative
field after central resection: the hilar plate and sectorial
right and left pedicles are visible; hepatic pedicle is encircled
with a white loop; in the upper portion of the field bleu and
white loops are around the three hepatic veins. |
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In
order to reduce the risk of postoperative liver failure, a preoperative
right portal embolization was planned to obtain a hypertrophy
of the left lobe. Therefore endoscopic drainage was performed
with two biliary stents (Fig. 4), and then right portal
embolization was carried out using titanium coils (Fig. 5). |
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| Fig. 4 and
5: surgical specimen: the hepatocellular carcinoma is 12 cm
in size, capsulated, without peritumoral or vascular invasion.
The resection was performed with minimun sacrifice of functioning
parenchyma, with respect of free margins. |
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Fig. 6: CT scan 20 months after resection:
no recurrence, with good hypertrophy of right and left lateral
sectors. |
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