Recurrent hepatocellular carcinoma treated by laparoscopic non-anatomical liver resection via the retroperitoneal approach: a case report

Background Repeat laparoscopic hepatic resection is an important treatment for recurrent hepatocellular carcinoma. However, intra-abdominal adhesions from prior open surgery and poor exposure of posterior segment lesions significantly increase surgical difficulty and risk. To address these challenges, we adopted an innovative retroperitoneal approach for recurrent segment VI hepatocellular carcinoma after previous open hepatectomy. Case presentation We report a case of a patient who had previously undergone open non-anatomical resection of a liver tumor in segment VII, followed by multiple sessions of transarterial chemoembolization and microwave ablation after tumor recurrence. At the 6th year of follow-up after hepatic resection, contrast-enhanced magnetic resonance imaging revealed a recurrent lesion measuring 2.0 × 1.6 cm in segment VI of the liver, adjacent to the adrenal gland. Given the patient's history of prior open surgery and multiple minimally invasive treatments, the possibility of intra-abdominal adhesions was considered. Moreover, the retroperitoneal approach allows direct exposure of the tumor in segment VI of the liver. Therefore, we selected the retroperitoneal approach combined with intraoperative ultrasound and successfully performed a laparoscopic non-anatomical resection of the segment VI liver tumor. The patient recovered smoothly postoperatively and was discharged uneventfully. Conclusion For highly selected patients with a small superficial segment VI tumor without major vascular invasion or severe cirrhosis, the retroperitoneal approach for repeat laparoscopic non-anatomical resection is feasible.