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Hemihepatic cascular occlusion during resection of segments III and IV for HCC in cirrhotic liver

In the cirrhotic liver with deep-seated multifocal hepatocellular carcinoma (HCC) hepatic resection should be carded out in anatomical planes, to avoid extensive bleeding and leave sufficient functional parenchyma. However the cirrhotic liver poorly tolerates complete liver ischemia, and every effort should be made to minimize the duration and extension of total hepatic vascular occlusion. CASE REPORT. The case of a 55-year-old male patient with a history of alcoholic cirrhosis, portal hypertension and with histologically proven chronic active hepatitis is reported. During follow up with liver ultrasound monitoring he was discovered to have hyperechogenic nodules in liver segment III (12mm diameter) and segment IV (25mm diameter). Needle biopsy of the nodules showed HCC; alphafetoprotein plasma level was high: 50 ng/dl. The patient underwent initially arterial chemoembolization with lipiodol-epirubicin and then was proposed for surgical resection of the bifocal neoplasia. The surgical treatment consisted of combined resection of segments III+ IV. We used the new hepatectomy method described by Makuuchi and coworkers, based on intermittent hemihepatic vascular occlusion, selective segmental devascularization and ultrasonically guided liver resection. This video describes the technique used.