Abstract
Background
Laparoscopic liver resection (LLR) is becoming essential in the treatment of malignant liver tumors but only a few reports exist about LLR for intrahepatic cholangiocarcinoma (IHCC).
Methods
We present a video of a laparoscopic left hemihepatectomy with lymphadenectomy for IHCC.
Case presentation
A 67-year-old asymptomatic male underwent a routine abdominal ultrasound, revealing a 15 × 9 mm solid nodular iso-hyperechoic lesion, located in SIII, with SII/III biliary duct dilation. Magnetic resonance imaging confirmed a 32 × 22 mm lesion in SII/III, with mild hyper-intensity on T2-weighted images and strong hypo-intensity on T1-weighted images. After administration of contrast medium, the lesion showed light peripheral enhancement on the portal and delayed phases, and hypo-intensity on the hepatospecific phase. No relevant comorbidities were reported (KPS 100). Laboratory tests showed normal liver function and normal CA19-9 levels. A laparoscopic left hemihepatectomy was indicated.
Results
Operative time was 330 min. Four intermittent Pringle maneuver cycles were applied and no blood transfusions were administered. Intraoperative ultrasound confirmed preoperative findings and additionally highlighted involvement of the SIV duct. A full replacing right hepatic artery arising from the superior mesenteric artery was identified and was preserved during hilar dissection. Postoperative course was uneventful and the patient was discharged on postoperative day 3. The pathology report indicated cholangiocellular carcinoma pT1bN0. Twelve lymph nodes were retrieved.
Conclusions
According to recent literature reports and our experience, laparoscopic surgery for intrahepatic cholangiocellular carcinoma should be considered feasible and safe in selected patients. Hepatic artery variations allow for adequate lymphadenectomy. Oncological long-term results require multicenter randomized studies in order to be validated.
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20 July 2022
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Acknowledgments
The authors would like to thank both the editor and the reviewers.
Funding
Open access funding provided by Tor Vergata University of Rome within the CRUI-CARE Agreement. No grants from any funding agency in the public, commercial, or not-for-profit sectors were received for this research.
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Alessandro Anselmo, Leandro Siragusa, Gennaro Pisani, Marco Materazzo, Brunella Pirozzi, and Giuseppe Tisone declare no conflicts of interest.
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Anselmo, A., Siragusa, L., Pisani, G. et al. Laparoscopic Left Hemihepatectomy for Intrahepatic Cholangiocellular Carcinoma: An Adequate Lymphadenectomy is Also Possible in Artery Variation. Ann Surg Oncol 29, 4359–4360 (2022). https://doi.org/10.1245/s10434-022-11549-6
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DOI: https://doi.org/10.1245/s10434-022-11549-6