Living donor liver transplantation with abdominal wall reconstruction for hepatocellular carcinoma with needle track seeding

Abstract

Malignant cell seeding in subcutaneous tissues along the needle track and/or percutaneous biliary drainage catheters is rare complication, but pose various technical issues in planning surgical treatment of such patients. If underlying primary hepatic malignancy can be treated, an aggressive resection of subcutaneous tissue bearing cancer cell with subsequent abdominal wall reconstruction has been sporadically reported. But, when hepatic resection is not possible due to underlying advanced cirrhosis, liver transplantation along with abdominal wall resection and subsequent reconstruction remains only feasible option. Herein, we describe our successful experience of living donor liver transplantation for hepatocellular carcinoma with full-thickness abdominal wall resection bearing the tumor seeding followed by reconstruction in single stage surgery.

Keywords: Living donor liver transplantation; Tumour seeding; Hepatocellular carcinoma; Abdominal wall resection

Core tip: Metastatic cell seeding can rarely occur in hepatocellular carcinoma secondary to procedures such as liver biopsy and percutaneous biliary drainage catheters. Abdominal resection bearing the malignant cells with resection of underlying liver cancer is the only curative option. But, if the resection of the liver is not possible due to poor underlying liver functions, liver transplantation (LT) can still be performed with excision of the subcutaneous malignant track. In this case report we are presenting our successful experience with living donor LT combined with abdominal wall resection and reconstruction using thigh myocutaneous pedicle flap in a single stage surgery.