A Case of Hepatocellular Carcinoma Successfully Treated by Portal Branch Ligation Followed by Hepatic Resection

Hiroaki Nagano, Morito Monden, Koji Umeshita, Mitsukazu Gotoh, Masato Sakon, Toshio Kanai, Syouhei Iijima, Yoshitaka Omachi, Takesada Mori, Jun Okamura*

Second Department of Surgery, Osaka University Medical School
*Osaka Teishin Hospital

A 55-year-old man was admitted to Osaka University Hospital for hepatocellular carcinoma in January 1986. Computed tomography (CT) one month after chemoembolization with lipiodol, adriamycin and gelfoam cube, revealed multiple nodules in the right lobe of the liver. Biopsy of the non-cancerous liver on laparoscopy revealed the presence of chronic inactive hepatitis. The results of liver function tests, such as ICG clearance and protein synthesis, showed moderate impairment. The volume of the right lobe, estimated by CT, was approximately 69.5% of the whole liver. Judging from ICG Rmax and other indexes, right lobectomy was contraindicated at this time. Therefore, portal branch ligation was performed as the first-step operation in February 1986. Six weeks later, CT showed marked atrophy of the right lobe and compensatory hypertrophy of the left lobe, the right lobe accounting for 51.5% of the whole liver. Portal branch ligation had no deleterious effects on liver function, and right lobectomy was indicated. The patient underwent the second operation 47 days after portal branch ligation. At laparotomy, marked hypertrophy of the left lobe was confirmed. Intraoperative ultrasonography showed that there were no metastatic nodules in the left lobe, and right lobectomy was performed. The patient had an uneventful postoperative course and was discharged 68 days after the resection. He is now alive 3 years and 1 month after the resection with tumor recurrence in the residual liver and the right adrenal gland. Portal branch ligation followed by liver resection is considered to be useful therapeutic modality, when the volume of the resecting liver is too large for one-stage resection.

Key words
hepatocellular carcinoma, portal branch ligation, hepatic resection

Reprint requests
Morito Monden Second Department of Surgery, Osaka University Medical School
1-1-50 Fukushima, Fukushima-ku, Osaka, 553 JAPAN

Accepted
November 8, 1989

To read the PDF file you will need Abobe Reader installed on your computer.