title: Left trisegmentectomy for hepatocellular carcinoma with tumor thrombi extending to the third branches in the remnant liver.
abstract: OBJECTIVE
  A successful left trisegmentectomy and tumor thrombectomy for hepatocellular carcinoma (HCC) of the right third branches in the remnant liver is described.
  
  
  METHODS
  In this case, the hepatocellular carcinoma originated in the internal segment of an HBs- and HBe-Ag positive cirrhotic liver, involved the portal vein of the umbilical portion across the portal trunk to the contralateral third branches, and had many metastatic nodules in the anterior segment of the liver. To remove tumor thrombi by directly visualizing the lumen of the third branches of the portal vein, the portal trunk to the anterior branch of the portal vein was completely isolated by transecting the hepatic parenchyma along the intersegmental plane through a hilar approach. Tumor thrombi were removed by incising the portal trunk toward the anterior branch of the portal vein. Portal flow to the remnant liver was restored preceding liver resection to preserve hepatic function. After division of the anterior Glissonean code, the left trisegment and caudate lobes of the liver were resected.
  
  
  RESULTS
  The patient was discharged 10 weeks after surgery and remained well for the first six months thereafter. Recurrent tumors, however, appeared in the remnant liver 7 months after surgery.
  
  
  CONCLUSIONS
  This procedure may be applicable in cases of HCC with portal tumor thrombi extending into the third branches in the remnant liver.
authors.affiliation: Second Department of Surgery, Gunma University School of Medicine, Maebashi, Japan. sohwada@sb.gunma-u.ac.jp
authors.forename: S
authors.initials: S
authors.lastname: Ohwada
authors.forename: S
authors.initials: S
authors.lastname: Nakamura
authors.forename: Y
authors.initials: Y
authors.lastname: Kawashima
authors.forename: I
authors.initials: I
authors.lastname: Kobayashi
authors.forename: T
authors.initials: T
authors.lastname: Ohya
authors.forename: Y
authors.initials: Y
authors.lastname: Iino
authors.forename: Y
authors.initials: Y
authors.lastname: Morishita
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D011168:Portal System / Q000601:surgery; D011169:Portal Vein / Q000601:surgery