The patient was a 74 year old woman with Child's A cirrhosis (likely on the basis of NASH) and an asymptomatic 4 cm hepatocellular carcinoma, identified during investigation of an unrelated problem. The bilirubin was 5 mmol/L , albumin was 40 g/L, INR was 1.03 and the platelet count was 340. The tumour was somewhat exophytic; it lay within segments VI & VII. Contrast-enchanced ultrasound confirmed the solitary lesion. Surgical resection is preferred over trans-arterial chemoembolization (TACE), radiation or Sorafenib. In the presence of cirrhosis, a parenchymal sparring procedure is preferred. Based on the relationship with the right hepatic vein, a formal resection of segment VI & VII was planned.

PL_segment67Resect – TVASurg – The Toronto Video Atlas of Surgery

Case description

The patient was a 74 year old woman with Child's A cirrhosis (likely on the basis of NASH) and an asymptomatic 4 cm hepatocellular carcinoma, identified during investigation of an unrelated problem.
The bilirubin was 5 mmol/L , albumin was 40 g/L, INR was 1.03 and the platelet count was 340.
The tumour was somewhat exophytic; it lay within segments VI & VII. Contrast-enchanced ultrasound confirmed the solitary lesion.
Surgical resection is preferred over trans-arterial chemoembolization (TACE), radiation or Sorafenib. In the presence of cirrhosis, a parenchymal sparring procedure is preferred. Based on the relationship with the right hepatic vein, a formal resection of segment VI & VII was planned.

CT scans

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Pathology slides