Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature

Figure 3 Treament and outcome of liver recurrence. The magnetic resonance imaging with gadolinium ethoxybenzyl dimeglumine demonstrates multiple liver metastases involving all liver segments except segment S1 (A). The patient underwent intraoperative ultrasonography-guided conservative liver resection (LR) (B), with intermittent hepatic pedicle clamping of 87 min. LR consisted of left lobectomy extended to segment 4a, with gentle detachment of a metastatic nodule from the left portal vein and the middle hepatic vein, respectively; multiple wedge resections in all the remnant liver segments, except S1; and radiofrequency thermal ablation of 3 nodules deeply located in segments S7, S8 and S1-S8, respectively.