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Tumoral clearance of the right portal hilar area: surprises beyond ‘no visual disease’
  1. Ghanim Khatib,
  2. Emine Gulen Kucukbingoz,
  3. İrem Hatipoglu and
  4. Mehmet Ali Vardar
    1. Çukurova University, Cukurova Universitesi, Adana, Turkey
    1. Correspondence to Dr Ghanim Khatib, Cukurova Universitesi, Adana, Turkey; ghanim.khatib{at}

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    A woman in her mid 40s was admitted with abdominal pain and weight loss for the last 6 months. The CT scan revealed a 13 cm mass with prominent solid components in the left ovary, retroperitoneal lymphadenopathy, and peritoneal carcinomatosis. No distant organ metastases were reported. The value of cancer antigen 125 (CA125) was 719. In this surgical Video 1, we demonstrate the clearance of tumorous implants determined by palpation at the right portal hilar area, which was not reported in the imaging and was not visualized during surgery. Final view of the tumoral clearance is demonstrated in Figure 1.

    Video 1 -
    Figure 1

    Image of the hepatic and portal areas after all implants are cleared. This image can be seen in the video at 5 min 45 s.

    Primary cytoreductive surgery was performed. Total peritonectomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy, and rectosigmoid resection were carried out with the Sarta-Bat approach.1 Non-visual disease at the right portal hilum covered by the gallbladder was palpated. Therefore, cholecystectomy was performed. After cholecystectomy, the tumorous implants at the posterior and right portal hilar area were clearly seen. First, the portal vein was identified and dissected from the tumor. Then, tumorous clearance continued above the right portal vein and right hepatic artery and their branches. During this procedure, uncontrolled bleeding occurred and was managed with direct finger press and by grasping with a clamp. After comprehensive control of the related area, vessels clips were placed. Additionally, total omentectomy, retroperitoneal lymphadenectomies, liver umbilical fissure excision, segment 6–7 glissonectomy and subcapsular metastasectomy, appendectomy, and side-to-end colorectal anastomosis were performed and complete cytoreduction was achieved.

    Currently, complete cytoreduction is described as no visual disease at the end of surgery. The term ‘no visual disease’ should be carefully interpreted. ‘No visual no palpable disease’ could be a more precise description.

    Data availability statement

    Data are available upon request.

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    Patient consent for publication

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    Not applicable.



    • Contributors GK: taking part in the surgery, video creation and voice-over, guarantor of the overall content. EGK: taking part in the surgery, video editing and submitting. İH: taking part in the surgery, video editing and submitting. MAV: management and decision of surgery and video.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.