Successful robotic extirpation of diaphragmatic seeding of hepatocellular carcinoma after previous rupture
- Resource Type
- Authors
- Paul B.S. Lai; John Wong; Andrew K Y Fung; Yue Sun Cheung; Charing C N Chong; Kit Fai Lee; Hon Ting Lok
- Source
- Journal of robotic surgery. 13(3)
- Subject
- Male
medicine.medical_specialty
Carcinoma, Hepatocellular
medicine.medical_treatment
Splenectomy
Diaphragm
030232 urology & nephrology
Diaphragmatic breathing
Health Informatics
Lesion
03 medical and health sciences
0302 clinical medicine
Neoplasm Seeding
Robotic Surgical Procedures
medicine
Humans
medicine.diagnostic_test
Rupture, Spontaneous
business.industry
Arterial Embolization
Liver Neoplasms
Margins of Excision
Middle Aged
medicine.disease
digestive system diseases
Diaphragm (structural system)
Treatment Outcome
Positron emission tomography
030220 oncology & carcinogenesis
Hepatocellular carcinoma
Resection margin
Surgery
Radiology
medicine.symptom
business
Tomography, X-Ray Computed
- Language
- ISSN
- 1863-2491
A 51-year-old man who was a hepatitis B carrier presented with ruptured hepatocellular carcinoma (HCC). Hepatic arterial embolization was performed for control of bleeding which was followed by staged open left lateral sectionectomy for tumor removal. Pathology confirmed a 3.5 cm ruptured subcapsular HCC in a cirrhotic liver with clear resection margin. However, the alpha-fetoprotein (AFP) increased from 14 to 72 µg/L after 7 months. A 1.7 × 0.8 cm nodule at left subdiaphragmatic region abutting on the spleen but no intrahepatic lesion was seen on computed tomography (CT). Dual tracer positron emission tomography suggested the nodule was a HCC seeding with no other recurrent tumor noted. Robotic exploration was offered to patient with the possibility of splenectomy. During operation, the nodule was adherent to the diaphragm with no splenic involvement. The lesion was locally excised. The diaphragmatic defect was closed with non-absorbable suture. Recovery was uneventful and the patient was discharged on postoperative day 4. Pathology confirmed HCC cells infiltrating to skeletal muscle and fibrous tissue. The resection margin was clear. Post-operatively AFP normalised. Serial abdominal CT and ultrasound revealed no evidence of recurrent disease. Patient had a disease-free survival of 47 months after excision of tumor seeding.