Centrally located small unifocal hepatocellular carcinoma between minor conservative liver resection and major hepatectomy.

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COD: 05_2816 Categorie: ,

Emilio De Raffele, Mariateresa Mirarchi, Carmelo Antonio Caserta, Dajana Cuicchi,
Gaspare Maria Pendino, Ferdinando Lecce, Stefano Cariani, Bruno Cola

Ann Ital Chir, 2018 89, 2: 113-117
Epub Ahead of Print – February 9

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in selected cases. Centrally located HCC (CL-HCC) are sited in central liver segments and may require complex LR because of
their relationship to major vascular and biliary structures and deep parenchymal location. Even though extended segment-oriented
resections are recommended for oncological reasons, more conservative LR may be indicated in patients with cirrhosis to preserve
an adequate function of the future remnant liver (FRL). To extend the indication to LR and to increase the safety of the surgical
procedure, preoperative portal vein embolization (PVE) or sequential transarterial embolization/chemoembolization (TAE/TACE)
and PVE have been widely used, to induce atrophy of the embolized segments involved by the tumor and compensatory hypertrophy
of the FLR. The most appropriate surgical strategy for small uninodular CL-HCC remains controversial, and should be decided
according to the features of the tumor at preoperative imaging, the relationship with major intrahepatic vessels and the expected
function of the FRL.
We report here two cases of elderly cirrhotic patients with unifocal small CL-HCC, where the surgical strategy was decided
according to the kind of relationship of the tumor with the hepatic hilum at preoperative imaging. In the first case there was no
clear evidence of neoplastic infiltration of the hilar vessels, so that a minor conservative LR was preferred. In the second patient
the tumor was suspected to infiltrate the right portal vein, and a major LR was performed after sequential TACE/PVE.

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