Laparoscopic liver resection for hepatocellular carcinoma in Fontan-associated chronic liver disease. The first case report

Roberta Angelico, Veronica Lisignoli, Lidia Monti, Rosanna Pariante, Chiara Grimaldi, Maria Cristina Saffioti, Maria Giulia Gagliardi, Marco Spada

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: A well-recognized long-term complication after Fontan procedure (FP), a complex cardiac surgery performed in patients with univentricular hearts, is the development of chronic liver disease and hepatocellular carcinoma (HCC). Due to the risk of cardiac and liver decompensation, liver resection of HCC is challenging and the laparoscopic approach has never been reported.

PRESENTATION OF THE CASE: We present the first case of laparoscopic liver resection (LLR) of HCC in a 33-years-old girl with cardiac-related cirrhosis after FP. Intraoperatively, the pneumoperitoneum was established at 8-10 mmHg and adequate fluid infusion was given to maintain the cardiac preload. After an ultrasound-guided thermoablation along the free-tumor margin of the hepatic lesion, a full laparoscopic non-anatomical resection of the tumor in segment V was performed, without Pringle manouver and blood transfusion requirement. The cardiac function remained stable during the surgery and thereafter, and the post-operative course was uneventful.

DISCUSSION: HCC in chronic liver disease after FP is associated with high-risk mortality. Due to the complex hemodynamic changes after FP, open surgical resections often aren't feasible and loco-regional percutaneous treatment or combined liver-heart transplantation are the only therapeutic options. This case suggests that LLR in FP patients has low-risk of liver and cardiac decompensation, minimizing the pneumoperitoneum insufflation to ensure low intra-abdominal/intra-thoracic pressures and providing accurate anaesthetic management to maintain proper cardiac preload and output.

CONCLUSION: LLR for HCC after FP is safe and feasible, and might be considered an alternative treatment of HCC for which the best treatment has not been defined yet.

Original languageEnglish
Pages (from-to)144-147
Number of pages4
JournalInternational Journal of Surgery Case Reports
Volume59
DOIs
Publication statusPublished - 2019

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Fontan Procedure
Liver Diseases
Hepatocellular Carcinoma
Chronic Disease
Liver
Pneumoperitoneum
Insufflation
Heart Transplantation
Therapeutics
Blood Transfusion
Cardiac Output
Liver Transplantation
Thoracic Surgery
Anesthetics
Fibrosis
Thorax
Hemodynamics
Pressure
Mortality
Neoplasms

Cite this

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title = "Laparoscopic liver resection for hepatocellular carcinoma in Fontan-associated chronic liver disease. The first case report",
abstract = "INTRODUCTION: A well-recognized long-term complication after Fontan procedure (FP), a complex cardiac surgery performed in patients with univentricular hearts, is the development of chronic liver disease and hepatocellular carcinoma (HCC). Due to the risk of cardiac and liver decompensation, liver resection of HCC is challenging and the laparoscopic approach has never been reported.PRESENTATION OF THE CASE: We present the first case of laparoscopic liver resection (LLR) of HCC in a 33-years-old girl with cardiac-related cirrhosis after FP. Intraoperatively, the pneumoperitoneum was established at 8-10 mmHg and adequate fluid infusion was given to maintain the cardiac preload. After an ultrasound-guided thermoablation along the free-tumor margin of the hepatic lesion, a full laparoscopic non-anatomical resection of the tumor in segment V was performed, without Pringle manouver and blood transfusion requirement. The cardiac function remained stable during the surgery and thereafter, and the post-operative course was uneventful.DISCUSSION: HCC in chronic liver disease after FP is associated with high-risk mortality. Due to the complex hemodynamic changes after FP, open surgical resections often aren't feasible and loco-regional percutaneous treatment or combined liver-heart transplantation are the only therapeutic options. This case suggests that LLR in FP patients has low-risk of liver and cardiac decompensation, minimizing the pneumoperitoneum insufflation to ensure low intra-abdominal/intra-thoracic pressures and providing accurate anaesthetic management to maintain proper cardiac preload and output.CONCLUSION: LLR for HCC after FP is safe and feasible, and might be considered an alternative treatment of HCC for which the best treatment has not been defined yet.",
author = "Roberta Angelico and Veronica Lisignoli and Lidia Monti and Rosanna Pariante and Chiara Grimaldi and Saffioti, {Maria Cristina} and Gagliardi, {Maria Giulia} and Marco Spada",
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doi = "10.1016/j.ijscr.2019.05.029",
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TY - JOUR

T1 - Laparoscopic liver resection for hepatocellular carcinoma in Fontan-associated chronic liver disease. The first case report

AU - Angelico, Roberta

AU - Lisignoli, Veronica

AU - Monti, Lidia

AU - Pariante, Rosanna

AU - Grimaldi, Chiara

AU - Saffioti, Maria Cristina

AU - Gagliardi, Maria Giulia

AU - Spada, Marco

N1 - Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.

PY - 2019

Y1 - 2019

N2 - INTRODUCTION: A well-recognized long-term complication after Fontan procedure (FP), a complex cardiac surgery performed in patients with univentricular hearts, is the development of chronic liver disease and hepatocellular carcinoma (HCC). Due to the risk of cardiac and liver decompensation, liver resection of HCC is challenging and the laparoscopic approach has never been reported.PRESENTATION OF THE CASE: We present the first case of laparoscopic liver resection (LLR) of HCC in a 33-years-old girl with cardiac-related cirrhosis after FP. Intraoperatively, the pneumoperitoneum was established at 8-10 mmHg and adequate fluid infusion was given to maintain the cardiac preload. After an ultrasound-guided thermoablation along the free-tumor margin of the hepatic lesion, a full laparoscopic non-anatomical resection of the tumor in segment V was performed, without Pringle manouver and blood transfusion requirement. The cardiac function remained stable during the surgery and thereafter, and the post-operative course was uneventful.DISCUSSION: HCC in chronic liver disease after FP is associated with high-risk mortality. Due to the complex hemodynamic changes after FP, open surgical resections often aren't feasible and loco-regional percutaneous treatment or combined liver-heart transplantation are the only therapeutic options. This case suggests that LLR in FP patients has low-risk of liver and cardiac decompensation, minimizing the pneumoperitoneum insufflation to ensure low intra-abdominal/intra-thoracic pressures and providing accurate anaesthetic management to maintain proper cardiac preload and output.CONCLUSION: LLR for HCC after FP is safe and feasible, and might be considered an alternative treatment of HCC for which the best treatment has not been defined yet.

AB - INTRODUCTION: A well-recognized long-term complication after Fontan procedure (FP), a complex cardiac surgery performed in patients with univentricular hearts, is the development of chronic liver disease and hepatocellular carcinoma (HCC). Due to the risk of cardiac and liver decompensation, liver resection of HCC is challenging and the laparoscopic approach has never been reported.PRESENTATION OF THE CASE: We present the first case of laparoscopic liver resection (LLR) of HCC in a 33-years-old girl with cardiac-related cirrhosis after FP. Intraoperatively, the pneumoperitoneum was established at 8-10 mmHg and adequate fluid infusion was given to maintain the cardiac preload. After an ultrasound-guided thermoablation along the free-tumor margin of the hepatic lesion, a full laparoscopic non-anatomical resection of the tumor in segment V was performed, without Pringle manouver and blood transfusion requirement. The cardiac function remained stable during the surgery and thereafter, and the post-operative course was uneventful.DISCUSSION: HCC in chronic liver disease after FP is associated with high-risk mortality. Due to the complex hemodynamic changes after FP, open surgical resections often aren't feasible and loco-regional percutaneous treatment or combined liver-heart transplantation are the only therapeutic options. This case suggests that LLR in FP patients has low-risk of liver and cardiac decompensation, minimizing the pneumoperitoneum insufflation to ensure low intra-abdominal/intra-thoracic pressures and providing accurate anaesthetic management to maintain proper cardiac preload and output.CONCLUSION: LLR for HCC after FP is safe and feasible, and might be considered an alternative treatment of HCC for which the best treatment has not been defined yet.

U2 - 10.1016/j.ijscr.2019.05.029

DO - 10.1016/j.ijscr.2019.05.029

M3 - Article

C2 - 31146196

VL - 59

SP - 144

EP - 147

JO - International Journal of Surgery Case Reports

JF - International Journal of Surgery Case Reports

SN - 2210-2612

ER -