Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 6, 2021; 9(22): 6469-6477
Published online Aug 6, 2021. doi: 10.12998/wjcc.v9.i22.6469
Successful totally laparoscopic right trihepatectomy following conversion therapy for hepatocellular carcinoma: A case report
Jun-Jing Zhang, Ze-Xin Wang, Jian-Xiang Niu, Ming Zhang, Ni An, Peng-Fei Li, Wei-Hua Zheng
Jun-Jing Zhang, Department of General Surgery, Huhhot First Hospital, Huhhot 010030, Inner Mongolia Autonomous Region, China
Ze-Xin Wang, Department of Interventional Medicine, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010000, Inner Mongolia Autonomous Region, China
Jian-Xiang Niu, Ming Zhang, Ni An, Peng-Fei Li, Wei-Hua Zheng, Department of Hepatobiliary Surgery, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot 010000, Inner Mongolia Autonomous Region, China
Author contributions: Zhang JJ reviewed the literature and drafted the manuscript, and was responsible for the revision of the manuscript for important intellectual content; Wang ZX analyzed and interpreted the imaging findings; Zhang JJ, Niu JX, and Zhang M were the patient’s surgeon; Li PF, Zheng WH, and An N were the postgraduates, reviewed the literature, and contributed to manuscript drafting; All authors issued final approval for the version to be submitted.
Supported by the Inner Mongolia Autonomous Region Grassland Talent Cultivation Program, No. CYYC2012040.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jun-Jing Zhang, MD, Chief Physician, Department of General Surgery, Huhhot First Hospital, No. 150 South Second Ring Road, Huhhot 010030, Inner Mongolia Autonomous Region, China. zhang.jj@vip.163.com
Received: April 7, 2021
Peer-review started: April 7, 2021
First decision: April 23, 2021
Revised: May 6, 2021
Accepted: May 25, 2021
Article in press: May 25, 2021
Published online: August 6, 2021
Processing time: 108 Days and 11.8 Hours
Abstract
BACKGROUND

About 20%-30% of newly diagnosed hepatocellular carcinoma (HCC) patients are surgically feasible due to a variety of reasons. Active conversion therapy may provide opportunities of surgery for these patients. Nevertheless, the choice of surgical procedure is controversial after successful conversion therapy. We report a patient with HCC who underwent successful laparoscopic right trisectionectomy after conversion therapy with portal vein embolization and transarterial chemoembolization.

CASE SUMMARY

A 67-year-old male patient presented to our hospital with epigastric distention/ discomfort and nausea/vomiting for more than 1 mo. Contrast-enhanced computed tomography scan of the abdomen demonstrated multiple tumors (the largest was ≥ 10 cm in diameter) located in the right liver and left medial lobe, and the left lateral lobe was normal. The future remnant liver (FRL) of the left lateral lobe accounted for only 18% of total liver volume after virtual resection on the three-dimensional liver model. Conversion therapy was adopted after orally administered entecavir for antiviral treatment. First, the right portal vein was embolized. Then tumor embolization was performed via the variant hepatic arteries. After 3 wk, the FRL of the left lateral lobe accounted for nearly 30% of the total liver volume. Totally laparoscopic right trisectionectomy was performed under combined epidural and general anesthesia. The in situ resection was performed via an anterior approach. The operating time was 240 min. No clamping was required during the surgery, and the intraoperative blood loss was 300 mL. There were no postoperative complications such as bile leakage, and the incision healed well. The patient was discharged on the 8th postoperative day. During the 3-mo follow-up, there was no recurrence and obvious hyperplasia of residual liver was observed. Alpha-fetoprotein decreased significantly and tended to be normal.

CONCLUSION

Due to the different biological characteristics of the liver cancer and the pathophysiological features of the liver from other organs, the conversion treatment should take into account both the feasibility of tumor downstaging and the volume and function of the remnant liver. Our case provides a reference for clinicians in terms of both conversion therapy and laparoscopic right trisectionectomy.

Keywords: Laparoscopy; Right trihepatectomy; Conversion therapy; Hepatocellular carcinoma; Primary liver cancer; Case report

Core Tip: Only 20%-30% of newly-diagnosed hepatocellular carcinoma (HCC) patients are feasible for surgical resection. We report a HCC patient who underwent successful laparoscopic right trisectionectomy after conversion therapy with portal vein embolization and transarterial chemoembolization. There are few reports in the literature. Our case provided reference for clinicians in terms of both conversion therapy and laparoscopic right trisectionectomy.