Successful robotic extirpation of diaphragmatic seeding of hepatocellular carcinoma after previous rupture
A 51-year-old man who was a hepatitis B carrier presented with ruptured hepatocellular carcinoma (HCC). Hepatic arterial embolization was performed for control of bleeding which was followed by staged open left lateral sectionectomy for tumor removal. Pathology confirmed a 3.5 cm ruptured subcapsular HCC in a cirrhotic liver with clear resection margin. However, the alpha-fetoprotein (AFP) increased from 14 to 72 µg/L after 7 months. A 1.7 × 0.8 cm nodule at left subdiaphragmatic region abutting on the spleen but no intrahepatic lesion was seen on computed tomography (CT). Dual tracer positron emission tomography suggested the nodule was a HCC seeding with no other recurrent tumor noted. Robotic exploration was offered to patient with the possibility of splenectomy. During operation, the nodule was adherent to the diaphragm with no splenic involvement. The lesion was locally excised. The diaphragmatic defect was closed with non-absorbable suture. Recovery was uneventful and the patient was discharged on postoperative day 4. Pathology confirmed HCC cells infiltrating to skeletal muscle and fibrous tissue. The resection margin was clear. Post-operatively AFP normalised. Serial abdominal CT and ultrasound revealed no evidence of recurrent disease. Patient had a disease-free survival of 47 months after excision of tumor seeding.
KeywordsHepatocellular carcinoma Tumor rupture Tumor seeding Robotic surgery
None of the authors assume any financial interest or support.
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Conflict of interest
Dr. Kit Fai Lee declares that he has no conflict of interest. Dr. Hon Ting Lok declares that he has no conflict of interest. Dr. Andrew KY Fung declares that he has no conflict of interest. Dr. Charing CN Chong declares that she has no conflict of interest. Dr. Yue Sun Cheung declares that he has no conflict of interest. Dr. John Wong declares that he has no conflict of interest. Prof. Paul BS Lai declares that he has no conflict of interest.
This article does not contain any studies with human participants or animals performed by any of the authors.
Written informed consent was obtained from the patient for publication of this Case Report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
- 5.Fung AKY, Chong CCN, Lee KF, Wong J, Cheung YS, Fong AKW, Lai PBS (2017) Outcomes of emergency and interval hepatectomy for ruptured resectable hepatocellular carcinoma: a single tertiary referral centre experience. Hepatoma Res 3:196–204Google Scholar
- 9.Ryu JK, Lee SB, Kim KH, Yoh KT (2004) Surgical treatment in a patient with multiple implanted intraperitoneal metastases after resection of ruptured large hepatocellular carcinoma. Hepatogastroenterology 51(55):239–242Google Scholar
- 13.Chou HS1, Lee KF, Yeh CN, Chen MF, Jeng LB (2005) Long-term survival following resection of peritoneal implantation from hepatocellular carcinoma: a case report. Hepatogastroenterology 52(64):1221–1223Google Scholar