Central hepatocellular carcinoma resection via separation of middle hepatic fissure: a report of one case and review of literature
Objective: To investigate the preoperative evaluation and surgical methods for central hepatocellular carcinoma. Methods: The clinical data of a patient with primary hepatocellular carcinoma located in deep position of segment VIII was analyzed retrospectively, and relevant literature review was also made. Results: Before operation, accurate liver function assessment and precise tumor localization, and then careful surgical planning were made for this patient; during operation, the liver parenchyma was split along the median fissure of the liver from the second porta hepatis at its superior plane to the first porta hepatis at its inferior plane, and then, liver parenchyma was separated along the line of the right hepatic vein, and was converged with the divided median fissure of the liver, after which, the tumor was completely excised with complete preservation of the right and middle hepatic veins. Postoperative CT examination showed that the right and middle hepatic veins were patent. Conclusion: Surgery for central hepatocellular carcinoma is difficult and has high risk. Adequate preoperative evaluation and appropriate selection of surgical methods are critical for surgical success.