Key result
Liver resection-preceding total hepatic vascular exclusion without cardiotomy enabled successful radical resection of hepatocellular carcinoma with right atrial tumor emboli, resulting in 2-year recurrence-free survival.
Case Report (n=1)
No
Liver resection-preceding total hepatic vascular exclusion without cardiotomy is a feasible and less invasive surgical option for hepatocellular carcinoma with tumor emboli extending into the right atrium.
Supports feasibility of less invasive resection for HCC with atrial extension; hypothesis-generating and should not change practice without further evidence.
右房内進展を伴う肝細胞癌の切除は人工心肺下での開心術を要し，肝切除のみに比べ侵襲が高い．我々は右房内へ進展した肝細胞癌に対し肝切除先行total hepatic vascular exclusion（全肝血行遮断；以下，THVEと略記）を達成，開心術をせず原発巣と右房内腫瘍栓を摘出しえた症例を経験した．本術式は心房内進展を伴う進行肝細胞癌に対し，開心術併用と比較し低侵襲術式になると思われた．症例は69歳男性で，検診で異常を指摘された．CT で肝右葉に右房内に進展する腫瘍を認め当院紹介となり，肝細胞癌の診断で手術を行った．術式は肝脱転，肝静脈根部剥離，右グリソン処理の後肝切離を行い，肝右葉が右肝静脈のみで繋がる状態とした．肝右葉の牽引により腫瘍栓が右房外に出ることをエコーで確認し，THVEの後に右肝静脈根部を切開，腫瘍栓と肝右葉を一括で摘出した．術後74日目に退院した．術後2年間，無再発生存中である．
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Ishino et al. (2015) conducted a case report in Hepatocellular carcinoma with tumor emboli in the right atrium (n=1). Liver resection-preceding total hepatic vascular exclusion (THVE) without cardiotomy was evaluated on Recurrence-free survival. Liver resection-preceding total hepatic vascular exclusion without cardiotomy enabled successful radical resection of hepatocellular carcinoma with right atrial tumor emboli, resulting in 2-year recurrence-free survival.
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