Successful totally laparoscopic right trihepatectomy following conversion therapy for hepatocellular carcinoma: A case report

Figure 1 Computed tomography result and three-dimensional reconstruction of the patient at first presentation. A: Venous phase contrast-enhanced computed tomography shows huge space-occupying lesions in the left medial lobe and right liver, and the left lateral lobe is normal; B: Virtual resection on the three-dimensional liver model.

Figure 2 Conversion therapy. A: Embolization of the right portal vein; B: Chemoembolization of the tumor in left medial lobe via left hepatic artery and abdominal trunk; C: Chemoembolization of tumors in the right liver via right hepatic artery and superior mesenteric artery.

Figure 3 Computed tomography result and three-dimensional reconstruction of the patient prior to surgery. A: Pre-operative venous phase contrast-enhanced computed tomography shows huge space-occupying lesions in the left medial lobe and right liver and obvious hyperplasia in the left lateral lobe; B: Virtual resection on the three-dimensional liver model.

Figure 4 Intraoperative observation. A: Liver remnant of the left lateral lobe, with normal color; B: Liver cutting surface, with intact Glisson sheath covering the left lateral lobe.

Figure 5 Resected specimen (diaphragmatic surface of liver). A: Microscopic findings. Hematoxylin and eosin (H&E) staining showing polygonal tumor cells in a trabecular arrangement, H&E × 400; B-D: Immunohistochemistry showing a strong and diffuse cytoplasmic (B) positivity with Hep Par 1 (C) and glypican 3 (D), × 400. The tumor cells were negative for cytokeratin 7 and cytokeratin 20.

Figure 6 Postoperative recovery and short-term follow-up. A: Abdominal plain computed tomography (CT) at discharge showed no accumulation of fluid in the abdominal cavity, whereas there was hyperplasia of the left lateral lobe; B: Abdominal incision at discharge; C: A recent CT scan showed that there was no tumor recurrence, and the hyperplasia of the left lateral lobe was obvious.

Figure 7 Change in alpha-fetal protein level.