Robotic emergency liver resection of ruptured hepatocellular carcinoma

Abstract

BackgroundThe spontaneous rupture of hepatocellular carcinoma (HCC) is a rare complication. The management of this complication needs a stepwise, multidisciplinary approach which considers first of all clinical conditions of the patient and also the possibility of the best curative treatment.MethodsWe report our experience of an emergency robotic liver resection for a ruptured HCC in an elderly patient. Minimally invasive liver resection is currently recognised as a safe and feasible approach to the treatment of HCC in elderly patients.ResultsOur patient presented haemodynamic stability, which allows us to perform a robotic resection of segment 3. To our knowledge, this is the first report of the application of a robotic platform in an emergency setting for liver resection.ConclusionsRupture of HCC is an uncommon complication, burdened by a high rate of mortality. Its management still remains controversial. Treatment should be individualised taking into consideration the clinical status of the patient, tumour features and possibility of centre therapeutic strategy.

The role of RObotic surgery in EMergency setting (ROEM): protocol for a multicentre, observational, prospective international study on the use of robotic platform in emergency surgery

“…Aside from acute diverticulitis and considered the increasing interest in elective robotic colorectal surgery, Maertens [ 15 ] offer a retrospective case series on ten emergent robotic colorectal surgeries getting a R0 associated with a proper lymph node dissection and no major complication or 30-day mortality. Another case of oncologic emergency surgery is reported by Conticchio [ 16 ] with a ruptured hepatocellular carcinoma treated with a robotic approach in a stable patient after trans arterial embolization failure. Last case series reported is by Ceccarelli [ 17 ] about five patients affected by strangulated hiatal hernias treated with laparoscopic or robotic approach.…”

Selective Arterial Embolization of Ruptured Hepatocellular Carcinoma with N-Butyl Cyanoacrylate and Lipiodol: Safety, Efficacy, and Short-Term Outcomes

“…However, supportive treatment alone is reserved for patients deemed too ill to receive surgical or radiological intervention, for instance, due to severe liver failure or an advanced tumor stage [8,19,20]. When possible, either open surgery or transarterial embolization (TAE) is performed [21][22][23]. Emergency open surgery to resect the involved part of the liver has curative potential but is not feasible if the liver reserve is limited and/or marked liver cirrhosis is present [8,24].…”