Detailed Abstract
[E-poster - Liver (Liver Disease/Surgery)]
[EP 065] Case of robotic major liver resection for primary hepatic angiosarcoma
Evgeniy ZAGAYNOV1, Aleksei KARACHUN1, Denis NESTEROV1, Timur LANKOV1, Gleb SAMSONOV1
1Department of Hepatobiliary and Pancreatic Surgery, N.N. Petrov National Medicine Research Center of oncology, Russia
Background : Hepatic angiosarcoma is a rare non-epithelial tumour, which often remains asymptomatic until becoming unresectable. At the same time, surgery still remains the main treatment option. So, finding safe and feasible surgical approaches is one of topical issues of angiosarcoma treatment.
Methods : A 76-year-old lady was diagnosed with a 2 cm lesion of liver segment VII during follow-up abdominal ultrasound for previously cured breast cancer. The lesion was pathologically verified as hemangioendothelioma and was found resectable in the extent of right hepatectomy. To confirm feasibility of such approach, Computer tomography (CT) liver volumometry and indocyanine green (ICG) functional test were performed, and remnant volume was calculated as 23,3% (208 ml) and ICG plasma disappearance rate was 21% per minute. The case was discussed on multidisciplinary team meeting: due to lesion’s location in close proximity to bifurcation of right Glissonean pedicle, locoregional treatment options were counterindicated, and patient was allocated to liver resection with prior right portal vein embolization.
Results : Three weeks after right portal vein embolization, remnant volume became 30%, and robotic right hepatectomy was performed. No intraoperative complications were encountered. Liver transection was done with cavitron ultrasonic surgical aspirator (CUSA™) via assistant’s port and right hepatic vein as well as right Glissonean pedicle were divided with endoscopic vascular stapler. Total operation time was 300 min and blood loss was 700 ml. On postoperative day 1 patient was transferred to the ward and had uneventful recovery. Specimen examination revealed 2cm high-grade angiosarcoma, located in 5 mm from resection margin, so no adjuvant treatment was administered. CT three months after surgery found no signs of progression.
Conclusions : Cases of liver angiosarcoma are sporadic and require efficient surgical treatment. Our results demonstrate that robotic major hepatectomy might be a safe and a feasible option for this group of patients.
Methods : A 76-year-old lady was diagnosed with a 2 cm lesion of liver segment VII during follow-up abdominal ultrasound for previously cured breast cancer. The lesion was pathologically verified as hemangioendothelioma and was found resectable in the extent of right hepatectomy. To confirm feasibility of such approach, Computer tomography (CT) liver volumometry and indocyanine green (ICG) functional test were performed, and remnant volume was calculated as 23,3% (208 ml) and ICG plasma disappearance rate was 21% per minute. The case was discussed on multidisciplinary team meeting: due to lesion’s location in close proximity to bifurcation of right Glissonean pedicle, locoregional treatment options were counterindicated, and patient was allocated to liver resection with prior right portal vein embolization.
Results : Three weeks after right portal vein embolization, remnant volume became 30%, and robotic right hepatectomy was performed. No intraoperative complications were encountered. Liver transection was done with cavitron ultrasonic surgical aspirator (CUSA™) via assistant’s port and right hepatic vein as well as right Glissonean pedicle were divided with endoscopic vascular stapler. Total operation time was 300 min and blood loss was 700 ml. On postoperative day 1 patient was transferred to the ward and had uneventful recovery. Specimen examination revealed 2cm high-grade angiosarcoma, located in 5 mm from resection margin, so no adjuvant treatment was administered. CT three months after surgery found no signs of progression.
Conclusions : Cases of liver angiosarcoma are sporadic and require efficient surgical treatment. Our results demonstrate that robotic major hepatectomy might be a safe and a feasible option for this group of patients.
SESSION
E-poster
E-Session 03/21 ALL DAY