ASO Visual Abstract: Extended Right Hepatectomy for Hepatocellular Carcinoma

Abstract Background Lenvatinib is a novel tyrosine kinase inhibitor that exhibits an antitumor effect on hepatocellular carcinoma (HCC). An established strategy that involves surgery and usage of lenvatinib for advanced HCC remains elusive. Case presentation A 58-year-old male patient with advanced HCC and untreated hepatitis B was referred to our hospital. The tumor at the right lobe was 10 cm in diameter with right portal vein thrombus. Because of the possible lung metastasis and concern about the remaining hepatic function after extended right hepatectomy, lenvatinib was initiated before surgery. After the confirmation of a sharp decrease of tumor markers during the 3-week lenvatinib therapy, only a right portal vein transection was done leaving the enlargement of the left lobe for improved post-hepatectomy liver function while lenvatinib therapy was continued. The laparotomy revealed that the tumor was invading the right diaphragm. After 7 weeks of lenvatinib administration after right portal vein transection, an extended right hepatectomy with resection of the tumor-invaded diaphragm was successfully done. The lung nodules that were suspected as metastases had disappeared. The patient has been doing well without any sign of recurrence for 1 year. Conclusion The strategy involving the induction of lenvatinib to conversion hepatectomy including the portal vein transection was effective for advanced HCC.

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Extended Right Hepatectomy for Hepatocellular Carcinoma

Annals of Surgical Oncology ◽

10.1245/s10434-021-10567-0 ◽

2021 ◽

Author(s):

F. Crafa ◽

S. Vanella ◽

E. Coppola Bottazzi ◽

A. Noviello ◽

A. Miro ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Right Hepatectomy ◽

Extended Right Hepatectomy

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Paraneoplastic Erythrocytosis: First Manifestation of a Large Hepatocellular Carcinoma Successfully Treated by Radical Liver Resection and Adjuvant Thalidomide

10.47496/nl.ajscr.2020.01.04 ◽

2020 ◽

pp. 1-4

Author(s):

Jorge A. Martínez ◽

Carlidia Ortega Peña ◽

Grecia Artigas ◽

Ana M Hudson ◽

Mayling Chang ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Resection ◽

Paraneoplastic Syndromes ◽

Right Hepatectomy ◽

Progressive Decrease ◽

Rare Manifestation ◽

Large Hepatocellular Carcinoma ◽

Extended Right Hepatectomy ◽

Radical Surgical Resection

The paraneoplastic syndromes occur in upto 28% of patients with hepatocellular carcinoma (HCC). Among them, erythrocytosis is reported as just 3.9 % of frequency. We describe a 59-year-old male patient with a large HCC in a non-cirrhotic liver presenting with erythrocytosis. Four phlebotomies were performed before radical surgical resection. Extended right hepatectomy was undertaken, proving a unifocal 10.2 X 13 X 6.5 cm, extensively necrotic HCC. There were no postoperative complications, and the patient was discharged on the 6th postoperative day. Adjuvant treatment with thalidomide was indicated for 36 months. We observed a progressive decrease in haemoglobin, haematocrit, EPO, and AFP to normal levels after the surgical procedure. A periodic follow-up with laboratory parameters and CT scan was done for 46 months with no evidence of relapses, until now. This case highlights a rare manifestation of advanced liver cancer; the first documented paraneoplastic erythrocytosis in a large HCC case in Chile was successfully treated by radical liver resection and adjuvant thalidomide.

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Consecutive Cases of Pure Live Donor Right or Extended Right Hepatectomy: Single Surgeon Initial 1-Year Experience

10.26226/morressier.58eb975cd462b80290b4fed4 ◽

2017 ◽

Author(s):

Suk Kyun Hong

Keyword(s):

Live Donor ◽

Right Hepatectomy ◽

Extended Right Hepatectomy

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En bloc transdiaphragmatic lung resection for locally advanced hepatocellular carcinoma: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa084 ◽

2020 ◽

Vol 2020 (6) ◽

Author(s):

Kit-fai Lee ◽

Randolph H L Wong ◽

Howard H W Leung ◽

Eugene Y J Lo ◽

Charing C N Chong ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Locally Advanced ◽

Left Lung ◽

Lower Lobe ◽

Uneventful Recovery ◽

Advanced Hepatocellular Carcinoma ◽

Right Hepatectomy ◽

En Bloc ◽

Liver Recurrence ◽

Lung Base

Abstract A 56-year-old man presented with an 11-cm hepatocellular carcinoma (HCC) at segment 7 of liver. To induce left liver hypertrophy, a sequential transarterial chemoembolization (TACE) and portal vein embolization before right hepatectomy were adopted. However, the tumor further increased in size despite TACE and invaded through the diaphragm to the right lung base. Anterior approach right hepatectomy with en bloc wedge resection of the involved right lower lobe of lung by endovascular staplers via transdiaphragmatic approach was performed. The diaphragmatic defect was closed with Goretex mesh. Patient made an uneventful recovery. Pathology confirmed a 12.5 cm poorly differentiated HCC invading through diaphragm to lung. During follow-up, patient developed a 6 cm recurrence at left lung base 17 months after surgery for which he received sorafenib therapy. However, the lung mass further increased in size with new liver recurrence at segment 3 despite treatment. He succumbed 2 years and 3 months after surgery.

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Oncological Outcomes after Liver Venous Deprivation for Colorectal Liver Metastases: A Single Center Experience

Cancers ◽

10.3390/cancers13020200 ◽

2021 ◽

Vol 13 (2) ◽

pp. 200

Author(s):

Salah Khayat ◽

Gianluca Cassese ◽

François Quenet ◽

Christophe Cassinotto ◽

Eric Assenat ◽

...

Keyword(s):

Portal Vein ◽

Liver Metastases ◽

Portal Vein Embolization ◽

Colorectal Liver Metastases ◽

Future Liver Remnant ◽

Small Sample ◽

Right Hepatectomy ◽

Liver Remnant ◽

Oncological Outcomes ◽

Extended Right Hepatectomy

Colorectal liver metastases (CRLM) are the major cause of death in patients with colorectal cancer (CRC). The cornerstone treatment of CRLM is surgical resection. Post-operative morbidity and mortality are mainly linked to an inadequate future liver remnant (FLR). Nowadays preoperative portal vein embolization (PVE) is the most widely performed technique to increase the size of the future liver remnant (FLR) before major hepatectomies. One method recently proposed to increase the FLR is liver venous deprivation (LVD), but its oncological impact is still unknown. The aim of this study is to report first short- and long-term oncological outcomes after LVD in patients undergoing right (or extended right) hepatectomy for CRLM. Seventeen consecutive patients undergoing LVD between July 2015 and May 2020 before an (extended) right hepatectomy were retrospectively analyzed from an institutional database. Post-operative and follow-up data were analyzed and reported. Primary outcomes were 1-year and 3-year overall survival (OS) and hepatic recurrence (HR). Postoperative complications occurred in 8 patients (47%). No deaths occurred after surgery. HR occurred in 9 patients (52.9%). 1-year and 3-year OS were 87% (95% confidence interval [CI]: ±16%) and 60.3%, respectively (95% CI: ±23%). Median Disease-Free Survival (DFS) was 6 months (CI 95%: 4.7–7.2). With all the limitations of a retrospective study with a small sample size, LVD showed similar oncological outcomes compared to literature reports for Portal Vein Embolization (PVE).

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