Laparoscopic right caudate lobectomy combined with right posterior lobectomy for hepatocellular carcinoma after neoadjuvant therapy (with video).

[BACKGROUND] Tumors located at the Caudate lobe are challenging due to proximity to major vessels, increasing recurrence risk and surgical difficulty. Neoadjuvant therapy has been explored for hepatocellular carcinoma (HCC) patients with higher risk of recurrence.

[METHODS] A 53-year-old female patient was admitted with hepatic mass detected during routine physical examination. PIVKA-II was 2143 mAU/ml and alpha-fetoprotein (AFP) was 8553 ng/ml. Contrast-enhanced magnetic resonance imaging demonstrated two discrete lesions, with tumor-related compression of the right hepatic vein and close anatomical proximity to the right portal vein trunk and posterior branch.

[RESULTS] Due to multiple tumors and proximity to major blood vessels with narrow margins, multidisciplinary consultation determined that neoadjuvant therapy was decided. Patient received donafenib continuously, three sessions of sintilimab and hepatic arterial infusion chemotherapy (HAIC), which resulted in marked tumor regression. Laparoscopic resection was performed. Pathological examination confirmed a diagnosis of HCC with low-grade differentiation and a major pathological response (MPR) with necrotic tumor area exceeding 70%. No evidence of recurrence was detected at the six-month's follow-up.

[CONCLUSION] Our findings demonstrate that laparoscopic caudate lobectomy after neoadjuvant therapy is a feasible approach for managing resectable HCC with high risk of recurrence located in the caudate lobe.