1
|
Kushiya H, Ambo Y, Takada M, Masuda T, Naraoka S, Hirano S. Right hepatectomy under cardiopulmonary bypass for hepatocellular carcinoma with inferior vena cava tumor thrombus: a case report. Surg Case Rep 2023; 9:175. [PMID: 37789134 PMCID: PMC10547666 DOI: 10.1186/s40792-023-01756-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/22/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND The prognosis of hepatocellular carcinoma (HCC) with vascular invasion is extremely poor, especially in patients with tumor thrombus (TT) of the inferior vena cava (IVC), which is an oncological emergency with a high risk of sudden death due to TT extension or migration. Herein, we describe a case of HCC with TT of the IVC that rapidly extended into the right atrium (RA), in which right hepatectomy was performed under cardiopulmonary bypass. CASE PRESENTATION A 64-year-old man was diagnosed with HCC with IVC TT, and right hepatic lobectomy was scheduled. While awaiting surgery, he complained of respiratory distress and rushed to the emergency room. The TT had reached the RA, and the patient was in a state of oncologic emergency. We requested the cooperation of the cardiovascular surgery department, and under artificial cardiopulmonary support, the right atrium was incised, and a part of the TT was removed. The IVC was clamped to prevent tumor dispersal, and right hepatic lobectomy was performed. The remaining thrombus was excised along with the right lobe of the liver by incising the IVC. There were no serious postoperative complications, and the patient is alive 1 year and 5 months postoperatively. CONCLUSION Hepatic resection with cardiopulmonary bypass could be an option for HCC with TT reaching the RA.
Collapse
Affiliation(s)
- Hiroki Kushiya
- Teine Keijinkai General Hospital, maeda 1 jo 12 Choume, Teine-ku, Sapporo, 006-0811, Japan.
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Yoshiyasu Ambo
- Teine Keijinkai General Hospital, maeda 1 jo 12 Choume, Teine-ku, Sapporo, 006-0811, Japan
| | - Minoru Takada
- Teine Keijinkai General Hospital, maeda 1 jo 12 Choume, Teine-ku, Sapporo, 006-0811, Japan
| | - Takahiko Masuda
- Teine Keijinkai General Hospital, maeda 1 jo 12 Choume, Teine-ku, Sapporo, 006-0811, Japan
| | - Shuichi Naraoka
- Teine Keijinkai General Hospital, maeda 1 jo 12 Choume, Teine-ku, Sapporo, 006-0811, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Kita 15 Nishi 7, Kita-ku, Sapporo, 060-8638, Japan
| |
Collapse
|
2
|
Zhang ZY, Zhang EL, Zhang BX, Zhang W. Surgery for hepatocellular carcinoma with tumor thrombosis in inferior vena cava: A case report. World J Clin Cases 2021; 9:11495-11503. [PMID: 35071583 PMCID: PMC8717523 DOI: 10.12998/wjcc.v9.i36.11495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 09/25/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) accompanied by a tumor thrombus is very common. However, the treatment strategy is controversial and varies by the location of the thrombus.
CASE SUMMARY We report herein a case of HCC with a tumor thrombus in the suprahepatic inferior vena cava (IVC), which was successfully treated by hepatectomy combined with thrombectomy following sorafenib chemotherapy. A 47-year-old woman with chronic hepatitis was diagnosed with HCC. Computed tomography and magnetic resonance imaging showed that the tumor lesion was located in the right half of the liver, and a tumor thrombus was detected in the suprahepatic IVC near the right atrium. After multi-departmental discussion and patient informed consent, right major hepatectomy and total removal of the tumor thrombus were successfully performed under cardiopulmonary bypass. There were no serious complications after surgery. Following sorafenib treatment, no recurrence has been detected so far (11 mo later).
CONCLUSION Surgical treatment followed by adjuvant sorafenib therapy might be an acceptable choice for HCC patients with tumor thrombosis in the IVC.
Collapse
Affiliation(s)
- Zun-Yi Zhang
- Research Laboratory and Hepatic Surgery Center, Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Er-Lei Zhang
- Research Laboratory and Hepatic Surgery Center, Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Bi-Xiang Zhang
- Research Laboratory and Hepatic Surgery Center, Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Wei Zhang
- Research Laboratory and Hepatic Surgery Center, Department of Hepatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| |
Collapse
|
3
|
Dantas E, Matos D, Coelho M, Sequeira C, Cardoso C, Oliveira AP. Hepatocellular Carcinoma with Atrial Extension: A Case Report. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2021; 28:360-363. [PMID: 34604468 DOI: 10.1159/000511643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/13/2020] [Indexed: 12/19/2022]
Abstract
Hepatocellular carcinoma is a common malignancy usually associated with cirrhosis. Despite being a highly aggressive tumor with several cases of vascular invasion, metastatic disease to the heart is a rare condition. A 65-year-old male cirrhotic patient was admitted with dyspnea, ascites, and lower extremity edema. A transthoracic echocardiogram showed a large mass in the right atrium. Further imaging studies revealed the presence of hepatocellular carcinoma extending from the liver to the right atrium through the inferior vena cava. The cardiac mass was surgically removed to treat the symptoms of right heart failure, but unfortunately the patient died on the 30th day after surgery due to septic shock.
Collapse
Affiliation(s)
- Eduardo Dantas
- Gastroenterology Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Daniel Matos
- Cardiology Department, Hospital Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Mariana Coelho
- Gastroenterology Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Cristiana Sequeira
- Gastroenterology Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Cláudia Cardoso
- Gastroenterology Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | - Ana Paula Oliveira
- Gastroenterology Department, Hospital São Bernardo, Centro Hospitalar de Setúbal, Setúbal, Portugal
| |
Collapse
|
4
|
Rorris FP, Tyrovolas K, Theodosis A, Tsamatsoulis M, Charitos C. Ectopic hepatocellular carcinoma in the adrenal gland with inferior vena cava thrombosis and right atrial extension. J Card Surg 2020; 35:1380-1382. [PMID: 32353896 DOI: 10.1111/jocs.14594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Intravascular tumor extension in the inferior vena cava (IVC) is known to occur with abdominal tumors, such as renal cell, hepatocellular, adrenal cell carcinoma, and Wilm's tumor. We encountered a 53-year-old male patient presenting with pulmonary embolism and a right atrial mass with imaging evidence of an adrenal tumor extending into the IVC, up to the right atrium. The patient underwent surgery for the resection of the tumor using cardiopulmonary bypass by a team of cardiothoracic surgeons and urologists. Histology identified the tumor as hepatocellular carcinoma, which developed as ectopic hepatic tissue in the right adrenal gland.
Collapse
Affiliation(s)
| | | | | | - Michalis Tsamatsoulis
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece
| | - Christos Charitos
- Department of Thoracic and Cardiovascular Surgery, Evangelismos General Hospital, Athens, Greece
| |
Collapse
|
6
|
Ohta M, Nakanishi C, Kawagishi N, Hara Y, Maida K, Kashiwadate T, Miyazawa K, Yoshida S, Miyagi S, Hayatsu Y, Kawamoto S, Matsuda Y, Okada Y, Saiki Y, Ohuchi N. Surgical resection of recurrent extrahepatic hepatocellular carcinoma with tumor thrombus extending into the right atrium under cardiopulmonary bypass: a case report and review of the literature. Surg Case Rep 2016; 2:110. [PMID: 27726114 PMCID: PMC5056913 DOI: 10.1186/s40792-016-0241-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/07/2016] [Indexed: 02/06/2023] Open
Abstract
Background Recurrent hepatocellular carcinoma accompanied by a right atrial tumor thrombus is rare. No standard treatment modality has been established. Surgical treatment may be the only curative treatment; however, surgery has been considered high risk. We herein describe a patient who underwent resection of a recurrent right atrial tumor thrombus under normothermic cardiopulmonary bypass on a beating heart. Case presentation A 60-year-old man underwent a right hepatectomy for hepatocellular carcinoma with diaphragm invasion. During the preoperative cardiac screening, he was diagnosed with an old myocardial infarction with triple-vessel coronary disease. Percutaneous coronary intervention was performed for the left anterior descending artery and left circumflex coronary artery. High-grade stenosis remained in his right coronary artery. Nine months later, computed tomography showed recurrent hepatocellular carcinoma in the diaphragm and a tumor thrombus extending from the suprahepatic inferior vena cava into the right atrium. Surgical resection of the recurrent tumor was performed through a right subcostal incision with xiphoid extension and median sternotomy. The recurrent tumor was incised with the diaphragm and pericardium. Intraoperative ultrasonography revealed that the tumor thrombus was free from right atrium wall invasion and that the right atrium could be clamped just proximal to the tumor thrombus. The right atrium, infrahepatic vena cava, left and middle hepatic veins, and hepatoduodenal ligament were encircled. Cardiopulmonary bypass was performed to prevent ischemic heart disease caused by intraoperative hypotension. Total hepatic vascular exclusion was then performed under normothermic cardiopulmonary bypass on heart beating. The inferior vena cava wall was incised. The tumor thrombus with the diaphragmatic recurrent tumor was resected en bloc. The patient had a favorable clinical course without any complications. Conclusion The recurrent hepatocellular carcinoma in the diaphragm and the right atrial tumor thrombus were safely resected using normothermic cardiopulmonary bypass on heart beating.
Collapse
Affiliation(s)
- Mineto Ohta
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan.
| | - Chikashi Nakanishi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Naoki Kawagishi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yasuyuki Hara
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Kai Maida
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Toshiaki Kashiwadate
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Koji Miyazawa
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Satoru Yoshida
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Shigehito Miyagi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yukihiro Hayatsu
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Shunsuke Kawamoto
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yasushi Matsuda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| | - Noriaki Ohuchi
- Division of Advanced Surgical Science and Technology, Graduate School of Medicine, Tohoku University, 1-1 Seiryou, Aoba, Sendai, 980-8574, Japan
| |
Collapse
|