Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini Hospital, Rome, Italy.
Ann Surg Oncol. 2022 May;29(5):2984. doi: 10.1245/s10434-021-11275-5. Epub 2022 Jan 10.
Despite the successful oncological results of liver transplantation, patients with hepatocellular carcinoma (HCC) can develop tumor recurrence. When technically feasible, liver resection represents the preferred treatment for recurrent HCC, even in the setting of transplanted patients. Recent progresses in minimally invasive liver resections have pushed the surgical community to attempt more challenging cases. We report a full laparoscopic left hepatectomy for HCC recurrence on transplanted liver.
A routine follow-up computed tomography (CT) scan of a 53-year-old male who previously underwent an orthotopic liver transplantation for alcoholic-related liver disease showed a 3 cm HCC in segment 4 in close relationship with the peripheral portion of the left portal pedicle. A full laparoscopic left hepatectomy was performed using an extrahepatic intraglissonean approach.
Operative time was 332 min and blood loss was 100 mL. The patient had an uneventful postoperative recovery and was discharged home after 3 days.
Laparoscopic liver resection on transplanted patients is feasible. Challenging clinical scenarios should only be attempted in referral centers and after an appropriate learning curve..
尽管肝移植在肿瘤学方面取得了成功，但肝细胞癌（HCC）患者仍可能出现肿瘤复发。在技术可行的情况下，肝切除术是复发性 HCC 的首选治疗方法，即使是在移植患者中也是如此。微创肝切除术的最新进展促使外科医生尝试更具挑战性的病例。我们报告了一例在移植肝上复发 HCC 的全腹腔镜左半肝切除术。
一名 53 岁男性，曾因酒精性肝病接受过原位肝移植，常规随访的 CT 扫描显示 4 段有一个 3cm 的 HCC，与左门脉蒂的外周部分关系密切。采用肝外 Glisson 鞘内入路行全腹腔镜左半肝切除术。
手术时间 332 分钟，失血量 100ml。患者术后恢复顺利，3 天后出院回家。
在移植患者中进行腹腔镜肝切除术是可行的。具有挑战性的临床情况仅应在转诊中心尝试，并在经过适当的学习曲线后进行。
