Successful Long-Term Survival With Various Modalities of Treatments Combining Minimally Invasive Surgery for Intrahepatic and Extrahepatic Recurrence of Hepatocellular Carcinoma: A Case Report.

A 63-year-old man received a robotic left lateral sectionectomy for a 2 cm solitary segment (seg) 2/3 hepatocellular carcinoma (HCC). Pathology revealed clear margins without vascular invasion. Three years later patient received transarterial chemo-embolization (TACE) for suspected intrahepatic recurrence. However, follow-up computed tomography (CT) revealed solitary peritoneal metastasis which increased to 8 cm at splenic hilum despite targeted therapy and immunotherapy was given, thus a robotic excision of the peritoneal metastasis with splenectomy was performed. CT at 3 months after surgery revealed solely new intrahepatic recurrences at segs 6 and 7. A total of four TACE were given subsequently. Laparoscopic seg 6/7 wedge liver resection was performed for residual disease. Two further small recurrences occurred at seg 7 at 2 years after surgery; stereotactic body radiotherapy (SBRT) was given. Ultimately, the patient was disease-free and enjoyed good quality of life for more than 10 years since the initial operation despite episodes of extrahepatic and intrahepatic recurrences. Thus, a multidisciplinary approach for HCC management is important to optimize treatment outcomes. Long-term cure is possible with multimodality treatment for recurrent HCC, and the use of minimally invasive surgery can enhance patient's quality of life.