LAUSR

Background/Aim: Hepatocellular carcinoma represents the most frequently encountered liver malignancy worldwide; however the dimensions of these lesions rarely surpass 20 cm. In such cases surgical treatment might encounter significant technical difficulties. Case Report: We present the case of a 49-year-old patient diagnosed with a 22/25/21 cm left lobe hepatocellular carcinoma. Results: In order to achieve a safe and effective resection total vascular exclusion was needed. Moreover, due to the anatomical relationship between the tumor and the cava vein, an intrathoracic approach of the inferior cava vein was the option of choice. The time of total vascular exclusion was of 26 minutes while the length of surgery was of 210 minutes; meanwhile the estimated blood loss was of 650 ml, while the postoperative outcome was uncomplicated. Conclusion: Total vascular exclusion by double approach might be a safe alternative in order to minimize the risks of severe intraoperative and postoperative complications.