Long-term survival after anterior approach right hepatectomy combined with inferior vena cava thrombectomy using trans-diaphragmatic intrapericardial inferior vena cava occlusion: a case report and review of the literature

Fig. 1. a CT scan showing a huge HCC located in the right hepatic lobe with tumor thrombus (arrow) entering the IVC. b Coronal CT suggests IVTT had passed the diaphragm level, but had not enter the right atrium (arrow). c Anterior approach right hepatectomy combined with IVCTT thrombectomy

Fig. 2. a Ligation of the right hepatic artery and portal vein. b The suprarenal IVC and portal vein were dissected and encircled (arrow). c The supradiaphragmatic IVC was encircled through a vertical incision of the diaphragm (arrow). d The sequence of total hepatic vascular exclusion: ① Suprarenal IVC ② The portal vein ③ Supradiaphragmatic IVC ④ Retrohepatic IVC

Fig. 3. a The resected tumor specimens. b Hepatocellular carcinoma, II-III, giant size, size 10 × 11 × 13 cm, visible intravascular tumor thrombus, incision without tumor residual (HE staining, × 400). c CT examinations and laboratory results of AFP showed no signs of recurrence or metastasis 32 months after the surgery

Fig. 4. IVCTT-presenting HCC is classified into three types. a The TT located within the subdiaphragmatic IVC; b The IVCTT extended above the diaphragm, but it had not infiltrated the RA; and (c) The TT extended over the diaphragm and had advanced into the RA