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Laparoscopic hepatectomy for hepatocellular carcinoma in patients with hemophilia A and B: a report of two cases

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Abstract

Hepatocellular carcinoma (HCC) is a life-threatening complication of hemophilia. Reports of patients with hemophilia undergoing hepatectomy for HCC are scarce. We report the cases of patients with hemophilia A and B who underwent laparoscopic hepatectomy for HCC. Perioperative hemophilia management was supervised by the hematology team. The patients received coagulation factor bolus injections immediately preoperatively, then continuous intravenous infusions intra- and postoperatively. A laparoscopic segment II partial hepatectomy was performed in case 1. Due to severe adhesions, intermittent pedicle clamping could not be used during parenchymal transection. The surgical duration was 235 min, and the estimated blood loss was 13 mL. The patient was discharged 11 days postoperatively without any complications. In case 2, laparoscopic partial hepatectomy for segments V/VI was performed. An intermittent pedicle clamp (Pringle method) was used during parenchymal transection. The surgical duration and estimated blood loss were 219 min and 18 mL, respectively. The patient was discharged 8 days postoperatively without complications. In both cases, intraoperative bleeding was minimal, and the patients were discharged without postoperative hemorrhage with appropriate perioperative coagulation factor management. Laparoscopic hepatectomy can be safely performed and appears to be a feasible treatment option for HCC in patients with hemophilia.

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References

  1. Srivastava A, Brewer AK, Mauser-Bunschoten EP, et al. Guidelines for the management of hemophilia. Haemophilia. 2013;19:e1-47.

    Article  CAS  PubMed  Google Scholar 

  2. Darby SC, Ewart DW, Giangrande PL, et al. Mortality from liver cancer and liver disease in haemophilic men and boys in UK given blood products contaminated with hepatitis C. UK Haemophilia Centre Directors’ Organisation. Lancet. 1997;350:1425–31.

    Article  CAS  PubMed  Google Scholar 

  3. Goedert JJ, Eyster ME, Lederman MM, et al. End-stage liver disease in persons with hemophilia and transfusion-associated infections. Blood. 2002;100:1584–9.

    CAS  PubMed  Google Scholar 

  4. Inokawa Y, Sugimoto H, Kanda M, et al. Hepatectomy for hepatocellular carcinoma in patients with hemophilia. J Hepato-Bil Pancreat Sci. 2014;21:824–8.

    Article  Google Scholar 

  5. Kobayashi K, Kokudo T, Yamaguchi T, et al. Hepatectomy in patients with inherited blood coagulation disorders can be safely performed with adequate coagulation factor replacement. Haemophilia. 2019;25:463–7.

    Article  CAS  PubMed  Google Scholar 

  6. Araki K, Harimoto N, Ishii N, et al. Optimal indications for an intercostal port for the superior segments in laparoscopic partial liver resection. Asian J Endosc Surg. 2020;13:382–9.

    Article  PubMed  Google Scholar 

  7. Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg. 1998;85:1058–60.

    Article  CAS  PubMed  Google Scholar 

  8. Iguchi T, Ikegami T, Fujiyoshi T, et al. Low positive airway pressure without positive end-expiratory pressure decreases blood loss during hepatectomy in living liver donors. Dig Surg. 2017;34:192–6.

    Article  PubMed  Google Scholar 

  9. Kobayashi S, Honda G, Kurata M, et al. An experimental study on the relationship among airway pressure, pneumoperitoneum pressure, and central venous pressure in pure laparoscopic hepatectomy. Ann Surg. 2016;263:1159–63.

    Article  PubMed  Google Scholar 

  10. Shetty S, Sharma N, Ghosh K. Epidemiology of hepatocellular carcinoma (HCC) in hemophilia. Crit Rev Oncol Hematol. 2016;99:129–33.

    Article  PubMed  Google Scholar 

  11. Shen SC, Harada A, Kurokawa T, et al. Partial hepatectomy for hepatocellular carcinoma in a patient with hemophilia: a case report. Hepatogastroenterology. 1994;41:283–6.

    CAS  PubMed  Google Scholar 

  12. Narushima Y, Ishiyama S, Kawashima K, et al. Operated hepatocellular carcinoma in two HIV− and HCV-positive hemophilic patients. J Hepato-Bil Pancreat Surg. 2004;11:207–10.

    Google Scholar 

  13. Jones AE, Roy A, Armstrong T, et al. Successful liver surgery in a haemophilia patient with high titre factor VIII inhibitor. Haemophilia. 2009;15:1332–3.

    Article  CAS  PubMed  Google Scholar 

  14. Hasegawa K, Takemura N, Yamashita T, et al. Clinical practice guidelines for hepatocellular carcinoma: The Japan Society of Hepatology 2021 version (5th JSH‐HCC guidelines). Hepatol Res. 2023;53:383–90.

    Article  PubMed  Google Scholar 

  15. Ng KKC, Chok KSH, Chan ACY, et al. Randomized clinical trial of hepatic resection versus radiofrequency ablation for early-stage hepatocellular carcinoma. Br J Surg. 2017;104:1775–84.

    Article  CAS  PubMed  Google Scholar 

  16. Takayama T, Hasegawa K, Izumi N, et al. Surgery versus radiofrequency ablation for small hepatocellular carcinoma: a randomized controlled trial (SURF trial). Liver Cancer. 2021;29:209–18.

    Google Scholar 

  17. Goka R, Morimoto N, Miura K, et al. Successful treatment of hepatocellular carcinoma by laparoscopic radiofrequency ablation in a patient with hemophilia A. Clin J Gastroenterol. 2020;13:907–13.

    Article  PubMed  Google Scholar 

  18. Yoshimoto-Haramura T, Hidaka M, Hasegawa K, et al. National survey of hepatobiliary and pancreatic surgery in hemophilia patients in Japan. J Hepato-Bil Pancreat Sci. 2022;29:385–93.

    Article  Google Scholar 

  19. Matsuda T, Umeda Y, Yoshida K, et al. Laparoscopic Hepatectomy for the patient with hemophilia a with high titer factor VIII inhibitor. Acta Med Okayama. 2021;75:199–204.

    PubMed  Google Scholar 

  20. Yin Z, Fan X, Ye H, et al. Short- and long-term outcomes after laparoscopic and open hepatectomy for hepatocellular carcinoma: a global systematic review and meta-analysis. Ann Surg Oncol. 2013;20:1203–15.

    Article  PubMed  Google Scholar 

  21. Takahara T, Wakabayashi G, Beppu T, et al. Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. J Hepato-Bil Pancreat Sci. 2015;22:721–7.

    Article  Google Scholar 

  22. White GC 2nd, Rosendaal F, Aledort LM, et al. Definitions in hemophilia. Recommendation of the scientific subcommittee on factor VIII and factor IX of the scientific and standardization committee of the International Society on Thrombosis and Haemostasis. Thromb Haemost. 2001;85:560.

    Article  CAS  PubMed  Google Scholar 

  23. Takatsuki M, Natsuda K, Hidaka M, et al. The treatment choices and outcome of hepatocellular carcinoma in hemophilic patients with human immunodeficiency virus/hepatitis C virus (HIV/HCV) coinfection due to contaminated blood products in Japan. J Gastrointest Oncol. 2021;12:2952–9.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Mariko Tsukagoshi, Norifumi Harimoto, Kenichiro Araki, Norihiro Ishii, Kei Hagiwara, Kouki Hoshino & Ken Shirabe

  2. Infection Control and Prevention Center, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Kunio Yanagisawa

  3. Department of Hematology, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan

    Yoshiyuki Ogawa & Hiroshi Handa

Authors
  1. Mariko Tsukagoshi
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  2. Norifumi Harimoto
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  3. Kenichiro Araki
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  4. Norihiro Ishii
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  5. Kei Hagiwara
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  6. Kouki Hoshino
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  7. Kunio Yanagisawa
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  8. Yoshiyuki Ogawa
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  9. Hiroshi Handa
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  10. Ken Shirabe
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Contributions

All the authors declare that they contributed to this article and have read and approved the final manuscript. MT reported this case and wrote the manuscript. MT, NH, KA, NI, KH, KH, and KS performed the surgery and perioperative management of the patients and helped draft the manuscript. KY, YO, and HH supervised the perioperative management of the hemophilia. KS participated in the critical revision of the manuscript.

Corresponding author

Correspondence to Mariko Tsukagoshi.

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The authors declare that there is no conflict of interest.

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All procedures were performed in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and the Helsinki Declaration of 1975, as revised in 2008(5).

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Written informed consent was obtained from both patients to publish this case report and any accompanying images.

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Tsukagoshi, M., Harimoto, N., Araki, K. et al. Laparoscopic hepatectomy for hepatocellular carcinoma in patients with hemophilia A and B: a report of two cases. Clin J Gastroenterol 16, 884–890 (2023). https://doi.org/10.1007/s12328-023-01854-2

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  • DOI: https://doi.org/10.1007/s12328-023-01854-2

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