Robot-assisted Laparoscopic Hepatectomy for Hepatocellular Carcinoma with Fontan-associated Liver Disease: a World-first Case Report

Overview

Journal Surg Case Rep

Specialty General Surgery

Date 2024 Sep 9

PMID 39249546

Authors

Takuma Ishikawa

Shinji Itoh

Takeo Toshima

Shohei Yoshiya

Yuki Bekki

Norifumi Iseda

Yuriko Tsutsui

Ichiro Sakamoto

Kotaro Abe

Tomoharu Yoshizumi

Affiliations

Soon will be listed here.

Abstract

Background: Fontan-associated liver disease (FALD) encompasses hepatic complications following the Fontan procedure, ranging from fibrosis to hepatocellular carcinoma (HCC). Despite advancements in surgical techniques and perioperative care, robot-assisted laparoscopic hepatectomy (RALH) for HCC in patients with FALD has not been previously reported owing to concerns about the Fontan circulation.

Case Presentation: We present the first case of RALH for recurrent HCC in a 45-year-old man after the Fontan procedure. The preoperative evaluation confirmed good cardiac function. The procedure involved meticulous monitoring and management of central venous pressure and was successfully completed with minimal blood loss. Postoperative recovery was uneventful. With thorough preoperative cardiac assessment and close collaboration between cardiologists and anesthesiologists, RALH can be safely performed in selected patients with FALD.

Conclusions: Even if a patient has a history of FALD, RALH can be safely performed in selected patients under appropriate conditions.

References

Mori M, Hirano S, Hakamada K, Oki E, Urushidani S, Uyama I . Clinical practice guidelines for telesurgery 2022 : Committee for the promotion of remote surgery implementation, Japan Surgical Society. Surg Today. 2024; 54(8):817-828. PMC: 11266380. DOI: 10.1007/s00595-024-02863-5. View

Takuma Y, Fukada Y, Iwadou S, Miyatake H, Uematsu S, Okamoto R . Surgical Resection for Hepatocellular Carcinoma with Cardiac Cirrhosis after the Fontan Procedure. Intern Med. 2016; 55(22):3265-3272. PMC: 5173492. DOI: 10.2169/internalmedicine.55.6869. View

Yokota Y, Noda T, Kobayashi S, Matsumoto K, Sakano Y, Iwagami Y . A case report of Fontan procedure-related hepatocellular carcinoma: pure laparoscopic approach by low and stable pneumoperitoneum. BMC Surg. 2020; 20(1):80. PMC: 7171803. DOI: 10.1186/s12893-020-00741-8. View

McClain C, McGowan F, Kovatsis P . Laparoscopic surgery in a patient with Fontan physiology. Anesth Analg. 2006; 103(4):856-8. DOI: 10.1213/01.ane.0000237294.88298.8e. View

Zhang L, Yuan Q, Xu Y, Wang W . Comparative clinical outcomes of robot-assisted liver resection versus laparoscopic liver resection: A meta-analysis. PLoS One. 2020; 15(10):e0240593. PMC: 7553328. DOI: 10.1371/journal.pone.0240593. View

Yoon J, Lee D, Cho E, Song M, Choi Y, Kim G . Risk of Liver Cirrhosis and Hepatocellular Carcinoma after Fontan Operation: A Need for Surveillance. Cancers (Basel). 2020; 12(7). PMC: 7408507. DOI: 10.3390/cancers12071805. View

Jarasvaraparn C, Thoe J, Rodenbarger A, Masuoka H, Payne R, Markham L . Biomarkers of fibrosis and portal hypertension in Fontan-associated liver disease in children and adults. Dig Liver Dis. 2024; 56(8):1335-1342. DOI: 10.1016/j.dld.2023.12.017. View

Kuwabara M, Niwa K, Toyoda T, Shirai T, Tateno S, Ohuchi H . Liver Cirrhosis and/or Hepatocellular Carcinoma Occurring Late After the Fontan Procedure　- A Nationwide Survey in Japan. Circ J. 2018; 82(4):1155-1160. DOI: 10.1253/circj.CJ-17-1053. View

Rychik J, Veldtman G, Rand E, Russo P, Rome J, Krok K . The precarious state of the liver after a Fontan operation: summary of a multidisciplinary symposium. Pediatr Cardiol. 2012; 33(7):1001-12. PMC: 3442163. DOI: 10.1007/s00246-012-0315-7. View

10.

Fruscione M, Pickens R, Baker E, Cochran A, Khan A, Ocuin L . Robotic-assisted versus laparoscopic major liver resection: analysis of outcomes from a single center. HPB (Oxford). 2019; 21(7):906-911. DOI: 10.1016/j.hpb.2018.11.011. View

11.

Grizzi F, Qehajaj D, Yiu D, Bresalier R, Chiriva-Internati M . PD-L1, fibrosis, and immunotherapy in hepatocellular carcinoma: the importance of a scientific method to explore observations and answer questions. Surg Today. 2020; 50(10):1318-1319. DOI: 10.1007/s00595-020-01965-0. View

12.

Heering G, Lebovics N, Agarwal R, Frishman W, Lebovics E . Fontan-Associated Liver Disease: A Review. Cardiol Rev. 2024; . DOI: 10.1097/CRD.0000000000000684. View

13.

Coletta D, Levi Sandri G, Giuliani G, Guerra F . Robot-assisted versus conventional laparoscopic major hepatectomies: Systematic review with meta-analysis. Int J Med Robot. 2021; 17(3):e2218. DOI: 10.1002/rcs.2218. View

14.

Nemoto S, Ariizumi S, Kotera Y, Omori A, Yamashita S, Kato T . A patient with post-Fontan operation underwent left hepatectomy and caudate lobectomy for hepatocellular carcinoma: a case report. Surg Case Rep. 2020; 6(1):104. PMC: 7237549. DOI: 10.1186/s40792-020-00866-1. View

15.

Stanton R, LURIE P, LINDESMITH G, MEYER B . The fontan procedure for tricuspid atresia. Circulation. 1981; 64(2 Pt 2):II140-6. View

16.

Kiesewetter C, Sheron N, Vettukattill J, Hacking N, Stedman B, Millward-Sadler H . Hepatic changes in the failing Fontan circulation. Heart. 2006; 93(5):579-84. PMC: 1955554. DOI: 10.1136/hrt.2006.094516. View

17.

Zhang L, Hu C, Qin Q, Li R, Zhao J, Zhang Z . Learning process analysis of robotic lateral pelvic lymph node dissection for local advanced rectal cancer: the CUSUM curve of 78 consecutive patients. Surg Today. 2023; 54(3):220-230. DOI: 10.1007/s00595-023-02725-6. View

18.

Giulianotti P, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T . Robotics in general surgery: personal experience in a large community hospital. Arch Surg. 2003; 138(7):777-84. DOI: 10.1001/archsurg.138.7.777. View

19.

Asrani S, Warnes C, Kamath P . Hepatocellular carcinoma after the Fontan procedure. N Engl J Med. 2013; 368(18):1756-7. DOI: 10.1056/NEJMc1214222. View

20.

Tsung A, Geller D, Sukato D, Sabbaghian S, Tohme S, Steel J . Robotic versus laparoscopic hepatectomy: a matched comparison. Ann Surg. 2013; 259(3):549-55. DOI: 10.1097/SLA.0000000000000250. View