Middle age female with a giant hepatic mass into right lobe diagnosed by tomography (hipovascular lesion with peripheral enhancement). She underwent both Endoscopy and colonoscopy which were without any alterations. Systemic statement showed only hepatic disease. A percutaneous biopsy showed a moderate adenocarcinoma with imnune-histochemical findings that suggested a intra-hepatic cholangiocarcinoma. She underwent in other province a palliative chemotherapy without any response. (first gencitabine and second Folfox) She still presents a good performance status and nutrition, besides that neither comorbidity nor underlying hepatic diseases. We performed a new statement, and her neoplasm is only restricted to the liver (although presents two small satellite lesions in right lobe). We are thinking about a curative resection a straightforward right hepatectomy with hilar lymphadenectomy or even some more liver sparing resection. She still presents an adequated volumetry for a right hepatectomy (about 30 % of residual liver). The question is : What is the best via for performing in this case? Open, laparoscopic ou robotic?
The final decisssion depends mostly of the previous experience of the surgical team in one of the two election procedures
Dear Sergio, I believe that an upfront right hepatectomy is the way to go. The best indication for minimally invasive liver resection, if you have the skills and experience to perform it, is anatomical resection. Whenever you know beforehand the type of liver resection you should perform, MI surgery is indicated. I prefer to do open the cases where there are multiple lesions in both livers and we dont know for sure which operation will be needed. In this particular case, I would perform it using MI surgery. I am using robotic approach for more complex cases, specially when we need hilar lymphadenectomy or biliary reconstruction. The lymphadenectomy is easier and better done, in my experience, by robotic approach. So in this case I would do it robotic.
Decision is in the surgical hand, based in the CT, MRI/MRCP, EUS and others staging methods. Is preffered open surgical approach. Experience is with priority.
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