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2015 ; 16
(ä): 52-5
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The hanging manoeuver to complete liver resection for a locally advanced
angiosarcoma: A case report
#MMPMID26413923
Cawich SO
; Thomas D
; Ragoonanan V
; Naraynsingh V
Int J Surg Case Rep
2015[]; 16
(ä): 52-5
PMID26413923
show ga
INTRODUCTION: Angiosarcomas arising in the liver are rare tumours in the Western
world. We report a case of a locally advanced primary hepatic angiosarcoma and
also describe the manoeuvres used to achieve operative resection. PRESENTATION OF
A CASE: A 52-year old woman presented with vague right upper quadrant pain.
Abdominal imaging revealed a heterogenous tumour in the right liver measuring
15centimetres in maximal diameter. Although the tumour was deemed to be
resectable, there was free fluid in the right paracolic gutter suggestive of
rupture. Intra-operatively, the peritoneal cavity was noted to be free of
metastatic disease. However, tumour was adherent to the diaphragm precluding
traditional mobilization of the liver. Therefore, a modified hanging manoeuvre
was performed using a nasogastric tube. This allowed controlled mobilization of
the right liver, parenchymal transection and en-bloc resection of the diaphragm
with good hemostasis. Histologic examination revealed a primary angiosarcoma with
uninvolved margins. DISCUSSION: When they occur, primary hepatic angiosarcomas
are most often locally advanced. Nevertheless, surgeons should be aggressive in
the pursuit of complete resections because this is the only therapeutic modality
that has been shown to have a survival advantage. CONCLUSION: Hepatobiliary
surgeons should keep the hanging manoeuver in their armamentarium when performing
complex liver resections for locally advanced angiosarcomas.