Surgery for difficult liver tumor

65 year old lady with dizziness episode, abdominal discomfort was diagnosed with acute onset severe anemia. Her investigations showed a liver tumor. She approached us with her reports.

On going through her detailed history, examination and previous investigations we realised that the liver tumor had actually spontaneously bled in the abdomen (hemoperitoneum), caused syncope and anemia. On further studies (CT / MRI / PET) and tumor markers it was evident that we were dealing with a highly vascular, atypical hepatocellular carcinoma which was in deepest part of liver (caudate lobe). After appropriate preoperative treatment for anemia, patient was taken up for surgery. An isolated caudate lobectomy was performed with very little blood loss and without blood transfusion. Patient recovered well after surgery and was discharged after 7 days.

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Caudate lobe of liver is a deepest part of liver. It is surrounded by important structures like vena cava, portal vein, hepatic artery and bile duct. Hence removal of caudate lobe tumors preserving all surrounding important structures and preserving rest of liver parenchyms is a challenge.