Case-report: Metastases in a low-stage middle-graded HCC in cleared HCV infection, non-cirrhotic liver: Surgical therapy.

INTRODUCTION: Hepatocellular carcinoma (HCC) is rare in non-cirrhotic liver. Achievement of sustained virological response (SVR) reduces even more the risk. PRESENTATION OF CASE: Liver resection for small HCC was performed in cleared HCV infection non-cirrhotic 62-year-old man. Methacronous oligometastatic recurrences in intolerant to Nexavar® side-effects patient, were treated by multiple innovative microinvasive approaches: bilateral laparoscopic adrenalectomy, thoracic wall resection, laparoscopic sacrum cryoablation combined with hadron-therapy. DISCUSSION: Therapies allowed the patient to lead 6 years satisfying QoL with only a small residual presacral disease stable at 8 months. CONCLUSION: Microinvasive surgery may be a valid resource of therapy in indolent HCC limited distant recurrences.