EDISCIENCES

ABSTRACT

Abstract Background the caudate lobe of the liver consists of three parts including Spiegel lobe, the paracaval portion and the caudate process portion (Coui- naud’s segment IX). The resection of a hepatocellular carcinoma (HCC) in this lobe always represents a challenge for the surgeon because of its position. Although local treatments have been propo- sed, surgery is still the best choice for treatment of HCC in the cau- date lobe. In this report we present the case of an anterior hepatic transection (AHT) for HCC of the segment IX in a 75-year-old man. Presentation of case A 75-year-old man was followed at out institution for ethylic cirrho- sis (CHILD A5, MELD Na 9), with detection of a single 29x30x30 mm HCC in the segment IX. Because of the presence of cirrhosis and the advanced age of the patient we opted for a segment IX resection with anterior hepatic approach (AHT). The post-operative course was regular, with the only complication of a biliary fistula ISGLS grade I. The patient died one year and a half later of pneu- monia, without HCC recurrence. Discussion Parenchyma sparing surgery has good oncological outcomes in HCC. In patients with liver cirrhosis is important performing the smallest possible resection avoiding the possibility of post-operati- ve hepatic decompensation, a very dangerous clinical entity espe- cially in older patients. In expert hands AHT for resection of HCC of the caudate lobe is feasible, offering the best view to the surgeon and minimalizing parenchyma resection. Conclusions Single segment IX resection for HCC performed by anterior approa- ch is a safe procedure in older patients with well compensated liver cirrhosis, with good oncological outcome. KEYWORDS Hepatocellular carcinoma, liver, anterior hepatic transection, caudate lobe, segment nine.