Case Report of a 58-Year-Old Woman with Anatomic Segment IV and VII Liver Metastases from a Primary Colonic Adenocarcinoma Who Underwent Laparoscopic Cone Segmental Partial Hepatectomy

Patient: Female, 58-year-old Final Diagnosis: Liver metastases Symptoms: No symptom Medication:— Clinical Procedure: Laparoscopic liver resection Specialty: Oncology • Surgery OBJECTIVE: Unusual setting of medical care BACKGROUND: Compared with wedge resection, anatomic segmental resection of liver metastases from primary colon cancer can improve tumor clearance and patient survival. We present the case of a 58-year-old woman with liver metastases from primary colon cancer who underwent laparoscopic cone unit resection for undetectable liver metastasis of segment VII. CASE REPORT: The patient was a 58-year-old woman. Giant uterine myoma and advanced sigmoid colon cancer were detected on computed tomography. Two liver metastases (segments IV and VII) were simultaneously detected. The lesion of segment VII (5.0 mm in size) was not detected by echography and was located in the root of the hepatic vein, which connects to the right hepatic vein. However, the echography detected the hepatic vein. Therefore, we set the vein as the landmark of the undetectable liver tumor and planned to perform cone unit resection of segment VII with resection of the hepatic vein laparoscopically. We detected the landmark-set hepatic vein on intraoperative echography and transected the peripheral Glisson VII. Subsequently, the right hepatic vein was exposed from the root to the peripheral side and transected in its root. Cone unit resection was performed without tumor exposure. Operation time and blood loss were 582 min and 200 g, respectively. Pringle maneuver time, including hepatectomy of segments IV and VII, was 146 min. She was discharged on postoperative day 5 with no postoperative complications. CONCLUSIONS: This case demonstrated the use of laparoscopic cone unit hepatectomy using an anatomical landmark in a patient with undetectable liver metastasis.