Retroperitoneal laparoscopic hepatectomy of recurrent hepatocellular carcinoma: case report and literature review
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CASE REPORT
Open Access
Retroperitoneal laparoscopic hepatectomy of recurrent hepatocellular carcinoma: case report and literature review Baifeng Li1, Tao Liu2, Yijie Zhang1 and Jialin Zhang1*
Abstract Background: Almost all liver tumours can be removed laparoscopically, but some difficult tumour locations complicate laparoscopic surgery. Recurrent liver tumours often pose great difficulties to laparoscopic surgery due to adhesions caused by previous operations. Referring to laparoscopic adrenalectomy, a retroperitoneal approach is proposed to remove liver tumours near the adrenal gland, which will provide a new method for liver surgery. Case presentation: Our case involves a patient with recurrent hepatocellular carcinoma (HCC) whose last operation was laparoscopic hepatectomy in our department, with a recurrence of HCC 2 years after the first surgery. In this case, based on preoperative CT and MRI, through a retroperitoneal approach, combined with intraoperative ultrasound (IOUS) localization and indocyanine green (ICG) fluorescence navigation, laparoscopic hepatectomy was successfully performed to precisely resect recurrent hepatocellular carcinoma in segment VII. The patient was discharged on the third day after the operation. The AFP decreased to normal levels on the 28th postoperative day. Conclusions: Retroperitoneal hepatectomy has the advantages of less trauma, shorter operation times, fewer complications and faster recovery for hepatic tumours near the adrenal gland. Accurate localization of tumours is needed to ensure accurate resection; therefore, IOUS and ICG fluorescence are very important. Liver parenchyma was severed strictly according to fluorescent labelling during hepatectomy, which prevented the deviation of liver parenchyma from the plane and ensured that the margin of hepatectomy was tumour-free. In order to ensure a radical resection of the tumour, it may be necessary to enter the abdominal cavity. Keywords: Retroperitoneal, Laparoscopic hepatectomy, Hepatocellular carcinoma (HCC), Intraoperative ultrasound (IOUS), Case report
Background Hepatocellular carcinoma (HCC) is a common malignancy, and hepatectomy is the first choice for the treatment of HCC. The laparoscopic technique has been widely used for liver surgery, and almost all tumours in any location in the liver can be removed laparoscopically [1–4]. However, some hepatic tumours, such as those near the adrenal gland (located in segment VII), are * Correspondence: [email protected] 1 Department of Hepatobiliary Surgery, the First Hospital of China Medical University, Shenyang, China Full list of author information is available at the end of the article
difficult to access during laparoscopic surgery because of their deep anatomical position and the complexities required for exposure of the surgical field [5]. Recurrent liver tumours often pose great difficulties in laparoscopic surgery due to adhesions caused by previous operations and are an important reason for conversion to open surgery [6, 7]. Therefore, laparoscopic surgery wi
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