[Chemical embolisation before laparoscopic hepatic resection in early hepatocellular carcinoma in cirrhotic patients].
OBJECTIVE
To assess whether preoperative transarterial chemoembolisation (TACE) reduces haemorrhage during laparoscopic resection, thus making the Pringle manoeuvre unnecessary and avoiding any subsequent complications.


METHODS
We present 3 cirrhotic Child A patients with early hepatocellular carcinoma, all of whom had been given the same treatment involving resection by laparoscopy and preoperative TACE of the segments to remove. All the nodules were located in the right hepatic lobe. One case was treated using total laparoscopic surgery and the two remaining cases were converted to the hand-assisted technique. In the first case we carried out bisegmentectomy VI-VII; in the second, segmentectomy VI plus radiofrequency of a second nodule in segment VII, and in the third case, segmentectomy V.


RESULTS
There was no morbidity or mortality. Blood transfusion was not required by any of the patients; in fact blood losses were 100, 50 and 150 ml, respectively, and it was not necessary to carry out the Pringle manoeuvre. Surgical margin was greater than 1cm in the three cases and hospital stay was less than 3, 3 and 4 days, respectively.


CONCLUSIONS
TACE prior to early hepatocellular carcinoma resection in cirrhotic patients seems to improve surgical safety with low blood losses without the use of the Pringle manoeuvre. Prospective random studies should be carried out on a larger number of patients in order to assess this technique.
Unidad de Cirugía Hepática y Trasplante Hepático, Departamento de Cirugía, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain. rirocam@um.es
Ricardo
R
Robles
Caridad
C
Marín
Asunción
A
López-Conesa
Antonio
A
Capel
Pascual
P
Parrilla
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care