About Prof. Qiu Shuangjian
Prof. Qiu Shuangjian is a leading hepatobiliary surgeon at Zhongshan Hospital, Fudan University. He specializes in surgical resection and minimally invasive treatment of primary liver cancer and intrahepatic cholangiocarcinoma. His expertise includes complex hepatectomy and multidisciplinary liver tumor management.
Case Overview
A 54-year-old male with a 20-year history of hepatitis B and compensated cirrhosis (Child-Pugh A) presented with an incidentally discovered 3.5 cm hepatocellular carcinoma (HCC) in Segment 8 of the liver — a surgically demanding location adjacent to the right and middle hepatic vein confluence. Prof. Qiu Shuangjian's team at Zhongshan Hospital, Fudan University performed a laparoscopic anatomical resection of Segment 8 with partial Segment 5, guided by real-time ICG fluorescence imaging. The patient was discharged on postoperative day 7 with no complications, and AFP normalized within one month.
Patient Background
- Age / Sex: 54-year-old male
- Chief Complaint: Incidental liver mass found on routine health check-up, 1 week prior
- Medical History: Chronic hepatitis B for 20 years (irregular antiviral treatment); no hypertension, diabetes, or alcohol use
- Physical Exam: Alert, no jaundice; palmar erythema present; no spider angiomata; abdomen soft, no hepatosplenomegaly, no ascites
Pre-operative Workup
Laboratory Results
- AFP: 480 ng/mL (elevated)
- HBV-DNA: 1.2 × 10⁵ copies/mL
- Liver Function: Child-Pugh Class A — Albumin 38 g/L, Bilirubin 18 μmol/L, PT 13s
- ICG-R15: 12% (borderline — indicating reduced hepatic reserve due to cirrhosis)
Imaging (Enhanced MRI)
- Nodular liver surface consistent with cirrhosis
- 3.5 cm × 3.0 cm Segment 8 mass: arterial enhancement with portal phase washout — classic HCC pattern
- Tumor abutting the root of the right hepatic vein (RHV) and the RHV–MHV confluence — deep and anatomically complex
- No satellite lesions or distant metastases
Multidisciplinary Team (MDT) Discussion
- Radiology: 3D reconstruction confirmed Segment 8 location; anatomical resection required for adequate margins
- Medical Oncology: No neoadjuvant therapy indicated; primary surgical resection recommended
- Hepatology: Immediate initiation of entecavir antiviral therapy and hepatoprotective agents advised
- Anesthesia: Cardiopulmonary assessment completed; low central venous pressure (LCVP) technique planned intraoperatively
Diagnosis & Surgical Strategy
Diagnosis: Primary hepatocellular carcinoma (cT1bN0M0, BCLC Stage A); hepatitis B-related cirrhosis.
Procedure: Laparoscopic anatomical resection of Segment 8 with partial Segment 5.
Rationale: The deep location of the tumor within Segment 8 made simple local excision inadequate — anatomical resection was required to eliminate potential microsatellite lesions along the portal territory. Given the underlying cirrhosis, the surgical plan prioritized maximum preservation of functional liver remnant (FLR). The laparoscopic approach was selected to minimize surgical trauma and support Enhanced Recovery After Surgery (ERAS) protocols.
Key Intraoperative Technologies
- ICG Fluorescence Negative Staining: ICG injected into the Segment 8 portal branch under ultrasound guidance; fluorescence mode delineated the ischemic boundary of S8 against S7 and S5 in real time
- Pringle Maneuver: Intermittent hepatic inflow occlusion to minimize blood loss
- Intraoperative Ultrasound (IOUS): Confirmed tumor position and relationship to hepatic veins throughout resection
Operative Procedure
- Position & Access: General anesthesia; reverse Trendelenburg position; 5-port laparoscopic layout
- Exploration: No ascites; nodular cirrhotic liver confirmed; no peritoneal metastases
- ICG Staining: Glisson sheath dissected at the hepatic hilum; S8 portal branch punctured under ultrasound guidance; 0.5 mg/mL ICG injected; fluorescence mode activated — S8 territory displayed clear negative staining (dark demarcation), precisely defining the resection boundary
- Parenchymal Transection: Ultrasonic scalpel and LigaSure used along the fluorescence boundary; vessels and bile ducts ≥3 mm clipped with Hem-o-lok; S8 hepatic vein branch divided with Endo-GIA vascular stapler
- Specimen Retrieval: Resected S8 and partial S5 tissue placed in retrieval bag; extracted via small lower abdominal incision
- Closure: Meticulous hemostasis confirmed; no bile leak; abdominal drain placed
Operative Data
- Operative Time: 180 minutes
- Estimated Blood Loss: ~150 mL (no transfusion required)
- Pringle Occlusion Time: 25 minutes cumulative (two intervals)
Pathology & Post-operative Recovery
Pathology Report
- Gross: Tumor 3.8 cm, intact capsule, surgical margin >1 cm — R0 resection confirmed
- Histology: Moderately differentiated hepatocellular carcinoma; microvascular invasion (MVI) Grade M1 (low risk)
- Immunohistochemistry: HepPar-1 (+), GPC-3 (+), CK19 (−)
Post-operative Course
- Day 1: Ambulating; drain output 50 mL (serosanguineous)
- Day 3: Oral intake resumed; mild transaminase elevation (ALT 150 U/L) managed with hepatoprotective therapy
- Day 7: Drain removed; discharged home
- Complications: None — no bile leak, no post-operative hemorrhage, no liver failure
Follow-up & Adjuvant Treatment
- 1 Month Post-op: AFP normalized (<20 ng/mL); enhanced CT showed compensatory hypertrophy of remnant liver; no recurrence
- Adjuvant Therapy: Given HBV-DNA positivity and low-risk MVI (M1), Prof. Qiu recommended initiating lenvatinib combined with a PD-1 inhibitor at one month post-surgery, continuing for one year to reduce recurrence risk
Expert Commentary — Prof. Qiu Shuangjian
1. Precision Surgery Through ICG Fluorescence Navigation
Traditional anatomical hepatectomy relies on intraoperative anatomical landmarks — a significant challenge in laparoscopic surgery compounded by cirrhotic parenchymal distortion. In this case, ICG fluorescence negative staining provided a real-time, visual demarcation of the Segment 8 portal territory, enabling a truly anatomical resection with confirmed R0 margins while preserving the maximum viable volume of Segments 5 and 7. For cirrhotic patients where every cubic centimeter of functional liver matters, this precision is not optional — it is essential.
2. Pushing the Boundaries of Minimally Invasive Hepatectomy
Segment 8 — located at the dome of the liver, adjacent to the major hepatic veins — has historically been considered a high-risk zone for laparoscopic resection. Through meticulous approach selection, controlled hepatic inflow management, and experienced vascular handling, the team achieved a blood loss of only 150 mL without transfusion. This reflects the standard of complex laparoscopic hepatectomy at Zhongshan Hospital's Department of Hepatobiliary Surgery.
3. MDT-Driven Comprehensive Management
This outcome was not the result of surgical skill alone. From pre-operative antiviral optimization and 3D volumetric planning, to post-operative targeted immunotherapy, every phase was coordinated across hepatology, radiology, medical oncology, and surgery. This multidisciplinary model is what transforms a technically successful operation into a durable improvement in long-term survival.
How CMCS Shanghai Coordinated This Case
China Medical Concierge Shanghai (CMCS) facilitated this patient's care pathway from initial inquiry through discharge and follow-up planning. Our coordination included:
- Pre-arrival medical record review and specialist matching with Prof. Qiu Shuangjian's team
- Arrangement of enhanced MRI, AFP panel, and HBV-DNA testing at Zhongshan Hospital
- MDT meeting attendance and bilingual interpretation of findings for the patient and family
- Surgical admission logistics, including visa support documentation and hospital registration
- On-site medical interpretation throughout the hospitalization
- Post-discharge follow-up coordination, including adjuvant therapy scheduling and remote check-in at one month
For international patients facing a liver cancer diagnosis, navigating a complex surgical pathway in a foreign country is daunting. CMCS exists to remove that barrier — connecting patients with China's top specialists while ensuring nothing is lost in translation, clinically or linguistically.
This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.
0 Kommentare