Complex Liver Resection As a Curative Surgery for HCC: A Case Study

By Federico Aucejo, MD

Liver resection continues to be a mainstay treatment for patients presenting with primary and secondary liver malignancies. In the case of hepatocellular carcinoma (HCC), liver resection is a curative alternative. However in HCC patients with cirrhosis and portal hypertension, liver transplantation is the standard of care.

Pretransplant locoregional therapy or liver resection are common approaches to keep patients within transplant eligibility. In line with this, organ allocation in HCC patients undergoing transplantation in the setting of severe organ scarcity continues to be challenging, as accurate predictors of posttransplant tumor recurrence are lacking.

At Cleveland Clinic’s Hepato-Biliary Cancer Center, we offer advanced surgical interventions via sophisticated surgical techniques to patients with complex tumors.

Vignette:

The patient is a 77-year-old male diagnosed with a large, central HCC abutting the portal vein bifurcation. After undergoing evaluation at a large, out-of-state tertiary facility, the patient received locoregional therapy but was denied surgery due to his age and advanced disease.

Seeking a surgical option and therefore a second opinion, the patient consulted the multidisciplinary Liver Tumor Clinic at Cleveland Clinic.

A large R0 central hepatectomy was successfully performed and the patient was discharged from the hospital on post-operative Day 7 without complications.

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Total vascular control (supra-hepatic and infra-hepatic vena cava, and liver hilum) in preparation for parenchymal transection.

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Cross sectional imaging via computed tomography demonstrating a large central liver mass (hepatocellular carcinoma).

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Surgical resection bed (histopathology analysis confirmed negative tumor margins).

References

1. Murali AR, Romero-Marrero C, Aucejo F, Menon KV. Hepatocellular carcinoma: options for diagnosing and managing a deadly disease. Cleve Clin J Med. 2013 Oct; 80:645-53.
2. Kumar AM, Fredman ET, Coppa C, El–Gazzaz G, Aucejo FN, Abdel-Wahab M. Patterns of cancer recurrence in localized resected hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int. 2015 Jun; 14:269-75.
3. Sasaki K, Firl DJ, Hashimoto K, Fujiki M, Diago-Uso T, Quintini C, Eghtesad B, Fung JJ, Aucejo FN, Miller CM. Development and validation of the HALT-HCC score to predict mortality in liver transplant recipients with hepatocellular carcinoma: a retrospective cohort analysis. Lancet Gastroenterol Hepatol. 2017 May S2468-1253: 30106-1.
4. Agopian VG, Harlander-Locke MP, Ruiz RM, et al. Impact of Pre-transplant Bridging Loco-regional Therapy for Patients With Hepatocellular Carcinoma Within Milan Criteria Undergoing Liver Transplantation: Analysis of 3601 Patients from the US Multicenter HCC Transplant Consortium. Ann Surg. 2017 Jun 26. PMID: 28654545