A case of deeply located small hepatocellular carcinoma in cirrhotic liver treated with laparoscopic small anatomic liver resection

The laparoscopic approach has weaknesses in terms of its inability to provide an adequate overview of the operative field and its lack of tactile sensation, easily leading to disorientation during surgery. This is especially true in liver resection for deeply located small tumors. Anatomic resection, which removes the portal territory of the tumorbearing area, is recommended for treatment of hepatocellular carcinoma (HCC) because it increases the chance of removing all transportal tumor cell dissemination and secures clearance of small tumors inside the area. Preservation of residual liver volume is also required for patients with deteriorated liver function. We performed laparoscopic small (one segment or less) anatomic liver resection for a deeply located small tumor in a cirrhotic liver with preoperative three-dimensional computed tomography (3D-CT) simulation. A 70-year-old man with hepatitis C virus-related liver cirrhosis was admitted for treatment of a lesion in liver segment 6. CT demonstrated a 1.0-cm lesion deep within segment 6 between the portal branches of subsegments 6a and 6c. The patient underwent laparoscopic anatomic liver resection of subsegments 6a and 6c using 3D-CT simulation. The deeply located small HCC was contained in the resected specimen with a negative margin, and pathological examination showed well-differentiated HCC. The patient’s postoperative course was uneventful, and he was well without recurrence 26 months postoperatively. Laparoscopic small anatomic liver resection with preoperative 3D-CT simulation facilitates removal of deeply located small tumors with an increased chance of removing transportal cancer cell dissemination, maximizing liver preservation, and achieving negative-margin resection.