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Annals of Surgical Oncology

, Volume 24, Issue 5, pp 1376–1377 | Cite as

Total Transthoracic Approach Facilitates Laparoscopic Hepatic Resection in Patients with Significant Prior Abdominal Surgery

  • Suguru Yamashita
  • Evelyne Loyer
  • Hyunseon C. Kang
  • Thomas A. Aloia
  • Yun Shin Chun
  • Reza J. Mehran
  • Cathy Eng
  • Jeffrey E. Lee
  • Jean-Nicolas Vauthey
  • Claudius Conrad
Hepatobiliary Tumors

Abstract

Background

While the oncologic safety of minimally invasive hepatectomy for colorectal liver metastases (CLM) has been demonstrated, lesions in the postero-superior segments may be challenging.1 3 For these lesions, a transthoracic approach may be particularly helpful, especially in patients with a hostile/reoperative abdomen or morbid obesity.4 , 5

Patient

A 43-year-old man with a body mass index of 36.0 who had undergone rectosigmoid resection for primary cancer 5 years ago recurred with a solitary liver metastasis in SVIII. He had previously undergone the following resections for metachronous CLM: (i) partial resections of SV/VIII and SII/III; (ii) ablation for SVII; and (iii) left hepatectomy, common bile duct resection, and choledochojejunostomy. Following four cycles of FOLFIRI/panitumumab with good response, the patient was considered for his fourth abdominal cancer intervention via a thoracoscopic approach.

Technique

In a modified French position with left-lung ventilation, access to the right thoracic cavity was gained. Following thoracic adhesiolysis, transdiaphragmatic intraoperative ultrasonography (IOUS) was performed. To ensure optimal margins, IOUS-guided transthoracic hepatic resection with partial resection of the diaphragm was conducted. The diaphragm was reconstructed and a chest tube placed. Operative time was 247 min, with an estimated blood loss of 100 mL. Postoperative recovery was uneventful; pathology demonstrated no viable tumor, with the closest margin 5 mm from the necrotic area.

Conclusion

Transthoracic hepatic resection of SVIII can optimize the port–target axis while minimizing morbidity. A systematic approach that includes precise port positioning, non-traumatic intrathoracic adhesiolysis, and meticulous transdiaphragmatic IOUS-guided parenchymal transection can optimize outcomes.

Notes

Disclosure

Suguru Yamashita, Evelyne Loyer, Hyunseon C. Kang, Thomas A. Aloia, Yun Shin Chun, Reza J. Mehran, Cathy Eng, Jeffrey E. Lee, Jean-Nicolas Vauthey, and Claudius Conrad have no conflicts of interest to declare.

Supplementary material

10434_2016_5685_MOESM1_ESM.mp4 (184.6 mb)
Supplementary material 1 (MP4 189059 kb)

References

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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Suguru Yamashita
    • 1
  • Evelyne Loyer
    • 2
  • Hyunseon C. Kang
    • 2
  • Thomas A. Aloia
    • 1
  • Yun Shin Chun
    • 1
  • Reza J. Mehran
    • 3
  • Cathy Eng
    • 4
  • Jeffrey E. Lee
    • 1
  • Jean-Nicolas Vauthey
    • 1
  • Claudius Conrad
    • 1
  1. 1.Department of Surgical Oncology, Hepato-Pancreato-Biliary SurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Diagnostic RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of Thoracic and Cardiovascular SurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Gastrointestinal Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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