Key result
Right hepatic lobectomy and removal of tumor emboli by total hepatic vascular exclusion without bypass procedures was successfully performed in a patient with HCC advancing into the right atrium, who remained recurrence-free at 26 months.
Case Report (n=1)
No
Removal of HCC tumor emboli in the right atrium combined with hepatectomy can be successfully performed without bypass procedures using total hepatic vascular exclusion.
This case suggests bypass-free resection may be feasible for HCC with right atrial extension; hypothesis-generating and needs prospective validation.
Among hepatocellular carcinomas (HCCs) advancing into the right atrium (RA), there are some cases which can be performed removal of tumor emboli and hepatectomy. A 70-year-old man was admitted to the hospital because of an 11cm HCC in the right lobe of the liver. Imaging diagnosis showed a large hypervascular mass advancing into the RA. Right hepatic lobectomy by anterior approach and removal of tumor emboli by total hepatic vascular exclusion (THVE) were performed without bypass procedures. THVE time was 15 minutes, operative time was 9 hours and 10 minutes and operative blood loss was 3450g. The resected specimen showed an 11cm massive tumor with intrahepatic metastases and tumor emboli in the right hepatic vein, inferior vena cava and RA. Histologically, hepatic tumors and tumor emboli were moderately differentiated HCC. His postoperative course was uneventful. He is alive and well without recurrence 26 months after the operation.
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Ozeki et al. (2000) conducted a case report in Hepatocellular carcinoma with tumor emboli in the right atrium (n=1). Right hepatic lobectomy and removal of tumor emboli by total hepatic vascular exclusion without bypass procedures was evaluated on Survival and recurrence. Right hepatic lobectomy and removal of tumor emboli by total hepatic vascular exclusion without bypass procedures was successfully performed in a patient with HCC advancing into the right atrium, who remained recurrence-free at 26 months.
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