Laparoscopic Surgery for an Intrapelvic-retroperitoneal Metastasis of Hepatocellular Carcinoma

Abstract

A 61-year-old man with a history of hepatocellular carcinoma (HCC) surgery, hepatitis B carrier state, and past hepatitis C infection underwent partial liver resection 9 years earlier and had been followed-up by laboratory tests (e.g., tumor markers) and abdominal computed tomography (CT). The level of serum protein induced by vitamin K absence or antagonist II (PIVKA-II) had been gradually increasing for one and a half years. A liver tumor and an intrapelvic mass were seen on abdominal CT at the same time. First, radiofrequency ablation (RFA) was performed to the liver tumor, but the level of PIVKA-II did not return to normal one month after RFA. In addition, abdominal CT showed enlargement of the intrapelvic tumor. Considering the possibility of HCC metastasis, the patient underwent laparoscopic intrapelvic mass resection. During the surgery, the intrapelvic mass was found to be located in the pararectal space and covered with peritoneum. Histopathological examination showed that the tumor was consistent with metastatic HCC. A rare case of solitary intrapelvic-retroperitoneal metastasis of HCC is presented along with a short literature review focusing on retroperitoneal metastasis of HCC.