A Case of Multiple Primary Cancers of the Colon and Liver Treated by Right Hepatic Trisegmentectomy after Laparoscopic Portal Branch Ligation

Abstract

An 82-year-old man was admitted to our hospital due to gross hematochezia. Colonoscopy showed a circumferential type 3 tumor in the sigmoid colon. Computed tomography (CT) showed multiple hepatocellular carcinomas (HCCs) with maximum diameters of 10 cm in S4/5/8 and 5 cm in S7, for which right hepatic trisegmentectomy was indicated because the predicted future liver remnant (FLR) was 43%. Laparoscopic portal vein ligation (PVL) was performed following laparoscopic sigmoidectomy. Four weeks postoperatively, the FLR reached 63% with ICG-K 0.072, and the patient underwent right hepatic trisegmentectomy. The patient had an uneventful postoperative course and underwent adjuvant chemotherapy for colonic cancer. Laparoscopic portal ligation is feasible in some patients with liver cancer concomitant with other gastroinstestinal disease. This method may be a superior choice for selected patients with HCC because it decreases potential morbidity associated with percutaneous transhepatic portal vein embolization.