Anterior transhepatic approach for hepatocellular carcinoma located in deep positions of segment VIII.

Liver resection for liver tumors located in deep positions in segment VIII remains a technical challenge. We successfully resected a hepatocellular carcinoma located in deep position in segment VIII and extended into the paracaval portion of the right caudate lobe, using an anterior transhepatic approach. The patient was a 73-year-old man with chronic hepatitis C. Preoperative ultrasonography and dynamic computed tomography revealed that the tumor was about 3.0 cm in diameter and close to the roots of the middle and right hepatic veins and the paramedian Glissonian pedicle. The right anterior artery was supplying the tumor. The liver was opened along the right side of the middle hepatic vein. The dorsal Glissonian pedicle of segment VIII was easily exposed, ligated, and divided. The dorsal part of segment VIII was removed, along with the paracaval portion of the right caudate lobe. The postoperative course was uneventful. The patient was disease-free 17 months after surgery. This anterior transhepatic approach provides a wide operating field and easy hemostasis, and could preserve the liver parenchyma as much as possible in a patient with liver dysfunction.