CENTRAL HEPATECTOMY AFTER TRASPARIETOHEPATIC PUNICATION PORTAL EMBOLIZATION

Introduction: Hepatocellular carcinoma is responsible for 70-85% of primary liver neoplasms and is one of the most common malignant tumors in the world. In patients with primary liver tumor, resection is the only potentially curative therapeutic option. However, one of the most important and limiting factors of this procedure is the remaining liver volume, which should be at least 30% of the total volume, to avoid complications such as postoperative liver failure. Thus, strategies have been developed to increase resectability in patients undergoing hepatectomy, such as: induction of hepatic hypertrophy through portal vein occlusion. With this type of approach it is possible to induce atrophy of the lobe affected by the tumor and consequently contralateral lobe hypertrophy through the deviation of portal venous flow. Portal vein occlusion can enlarge the remaining liver by up to 40% within three to eight weeks. Objectives: Video presentation of central hepatectomy of hepatocarcinoma after portal embolization by transparietohepatic puncture. Methods: Patient J.S.B, male, 44 years old, with a history of smoking, alcoholism and alcoholic liver cirrhosis (Child A). The abdomen tomography showed a 4cm x 4cm x 4cm nodular lesion in hepatic segments V and VIII adjacent to the right portal vein branch. He underwent VLP (diagnostic videolaparoscopy) and videolaparoscopy-guided hepatic biopsy. The pathological examination showed hepatocarcinoma. After anatomopathological results, a two-step surgery was scheduled. In the first time, the right branches of the portal vein were embolized by transparietohepatic puncture. In the second moment, he performed segment V and VIII hepatectomy in monobloc + cholecystectomy by videolaparoscopy. Results: The patient underwent a two-step surgery for resection of hepatocellular carcinoma by laparoscopy in the right lobe of the liver, with good intraoperative and postoperative evolution. Conclusion: Portal vein embolization is a procedure that allows the growth of the future remaining liver, supporting the possibility of extensive hepatic resection in patients with predictable insufficient remaining liver volume. Thus, it is possible to perform hepatectomies with larger parenchymal volume without presenting liver failure in the postoperative period of patients with hepatocarcinoma.

 

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Artikel online veröffentlicht:
23. Oktober 2019