A Case of Laparoscopic Partial Hepatectomy for Hepatocellular Carcinoma in a Patient with Severe Chronic Obstructive Pulmonary Disease

Abstract

A 79-year-old male with a history of hepatitis C was diagnosed with a hepatocellular carcinoma (HCC) measuring 2 cm in size in S4 of the liver. Preoperative examination revealed the presence of a severe obstructive disorder due to chronic obstructive pulmonary disease (COPD). The location and size of the tumor indicated that laparoscopic partial hepatectomy was the optimal surgical approach ; however, there were concerns regarding the risk of general anesthesia and insufflation due to low pulmonary function. Therefore, a decision was made to perform laparoscopic surgery after comprehensive consultation with the relevant departments.

A laparoscopic partial hepatic S4 resection was performed and the patient was discharged without complications on postoperative day 7. Postoperative pathology revealed an intermediately differentiated HCC (pT1N0M0 pStage I).

Laparoscopic surgery has advantages over open surgery, including smaller wounds, less postoperative pain, and a shorter hospital stay. However, there are concerns about the effects of pneumoperitoneum on circulation in elderly patients and patients with respiratory diseases. Furthermore, the criteria for laparoscopic surgery in patients with respiratory dysfunction are not clearly defined. Here, we describe a case of laparoscopic hepatectomy performed safely in an elderly patient with severe COPD.