Dados do Trabalho

Título

VIDEOLAPAROSCOPIC LEFT HEPATECTOMY USING EXTRA-GLISSONIAN APPROACH FOR THE TREATMENT OF HEPATOCARCINOMA: A CASE REPORT

Apresentação do Caso

Patient J.O.P.O., 75 years old, male, with hypertension and insulin-dependent diabetes, former smoker and former alcoholic. He presented with heartburn, gastric burning, and postprandial fullness over the past few years, worsening in the last month. Imaging studies revealed a tomographic finding of an expansive lesion with imprecise margins, showing heterogeneous enhancement with intravenous contrast, measuring approximately 8.0 x 6.0 cm, likely neoplastic, suggesting intrahepatic cholangiocarcinoma. Chest tomography, endoscopy, and colonoscopy did not show evidence of tumor lesions, and the CEA marker was 1.3. The patient underwent left hepatectomy via laparoscopic approach for segments II and III, using extra-glissonian access, without lymphadenectomy, and the histopathological exam result was consistent with hepatocellular carcinoma. Post-procedure, the patient developed hepatic encephalopathy related to cirrhosis diagnosed intraoperatively, but it resolved with intensive care unit management. The patient is currently under follow-up with clinical oncology.

Discussão

Incidence and mortality rates due to primary liver cancer have been increasing in recent years. Cirrhosis, primarily caused by hepatitis B and C viruses, along with lifestyle factors such as alcohol abuse and fatty liver disease, are the main causes of chronic hepatic degradation that can lead to hepatocellular carcinoma. This tumor is typically diagnosed late in its course, and its average survival after diagnosis mainly depends on the possibility of transplantation or resectability. Staging is based on the extent and spread of hepatocellular carcinoma, the severity of hepatic cirrhosis, and the patient's functional capacity. When feasible, surgical treatment can offer long-term survival with a good quality of life. The type of hepatic resection depends on the location of the lesion, the severity of cirrhosis, and the surgeon's preference. Laparoscopic or robotic resection is viable and safe but requires an experienced professional due to its steep learning curve.

Comentários Finais

Hepatic resection is a therapeutic option with potential for cure and is the preferred approach for patients meeting the necessary criteria. However, there is no defined consensus for selecting suitable patients, and practices may vary.