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Chao WS, Shen CH, Luo SC, Wu FH, Wei HJ, Yu CL, Wu CC, Yen Y, P’eng FK. Concomitant Hepatectomy and Atrial Thrombectomy under Cardiopulmonary Bypass versus Staged Hepatectomy in the Treatment for Hepatocellular Carcinoma with Large Right Atrial Tumor Thrombi. J Clin Med 2022; 11:jcm11082140. [PMID: 35456235 PMCID: PMC9025558 DOI: 10.3390/jcm11082140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/03/2022] [Accepted: 04/09/2022] [Indexed: 11/20/2022] Open
Abstract
(1) Background: Hepatocellular carcinoma (HCC) with a large right atrium tumor thrombus (RATT) is a rare and critical presentation. Emergency hepatectomy and thrombectomy under cardiopulmonary bypass (CPB) is life-saving and potentially curative. The aim of this study is to propose an appropriate approach for this condition. (2) Methods: In period A (1998 to 2010, n = 7), hepatectomy and thrombectomy were concomitantly performed, and staged hepatectomy was performed in period B (2011 to 2018, n = 17). (3) Results: The median overall survival time (MOST) in the published studies was 14 months. Moreover, the blood loss, blood transfusion rate, length of ICU stays, and hospital costs were significantly reduced in period B. The MOSTs of patients in period A (n = 6) and period B (n = 17) were 14 vs. 18 months (p = 0.099). The median disease-free survival times (MDFTs) in period A (n = 6) and period B (n = 15) were 8 vs. 14 months (p = 0.073), while the MOSTs in period A and period B were 14 vs. 24 months (p = 0.040). (4) Conclusions: Emergency thrombectomy under CPB and staged hepatectomy 4–6 weeks later may be an appropriate approach for HCC with large RATT. However, the optimal waiting interval requires further investigation.
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Affiliation(s)
- Wen-Shan Chao
- Department of Surgery, Ministry of Health and Welfare Feng Yuan Hospital, Taichung City 42055, Taiwan;
| | - Ching-Hui Shen
- Departments of Anesthesiology, Taichung Veterans General Hospital, Taichung City 40705, Taiwan;
- Department of Anesthesiology, Faculty of Medicine, National Yang-Ming University, Taipei City 112304, Taiwan
| | - Shao-Ciao Luo
- Departments of Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (S.-C.L.); (C.-C.W.); (F.-K.P.)
| | - Feng-Hsu Wu
- Departments of Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (S.-C.L.); (C.-C.W.); (F.-K.P.)
- Department of Nursing, Hung Kuang University, Taichung City 433304, Taiwan
- Correspondence: ; Tel.: +886-4-23592525; Fax: +886-4-23595046
| | - Hao-Ji Wei
- Departments of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (H.-J.W.); (C.-L.Y.)
| | - Chu-Leng Yu
- Departments of Cardiovascular Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (H.-J.W.); (C.-L.Y.)
| | - Cheng-Chung Wu
- Departments of Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (S.-C.L.); (C.-C.W.); (F.-K.P.)
- Department of Surgery, Faculty of Medicine, National Yang-Ming University, Taipei City 112304, Taiwan
| | - Yun Yen
- Cancer Translation Research Center, Taipei Medical University, Taipei City 106, Taiwan;
| | - Fang-Ku P’eng
- Departments of Surgery, Taichung Veterans General Hospital, Taichung City 40705, Taiwan; (S.-C.L.); (C.-C.W.); (F.-K.P.)
- Department of Surgery, Faculty of Medicine, National Yang-Ming University, Taipei City 112304, Taiwan
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Sikora SS, Bharathy KGS, Krishnan P, Babu P. Twelve-Year Survival After Resection of Hepatocellular Carcinoma with Right Atrial Tumor Thrombus. J Gastrointest Cancer 2021; 52:1169-1174. [PMID: 34196937 DOI: 10.1007/s12029-021-00659-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION A large hepatocellular carcinoma (HCC) with macrovascular invasion is generally considered to have poor prognosis due to unfavorable tumor biology andsuch patients are relegated to palliative options. This report describes long term survival after surgery in a patient with HCC and tumor thrombus in the rightatrium. METHODS Case records of the patient, details of follow up visits and surveillance computed tomography scans performed were reviewed. A brief discussion of thesurgical strategy adopted along with outcome of similar cases in literature is presented. RESULTS A 60 year old man presented with a HCC in segments 4, 5 with extension of tumor into the middle, left hepatic veins, inferior vena cava and right atrium.Patient underwent extraction of the tumor thrombus from the right atrium under cardiopulmonary bypass along with extended left hepatectomy. He receivedthree cycles of adjuvant chemotherapy with Gemcitabine, Oxaliplatin and Interferon. There was a parietal wall recurrence after 1 year and 10 months whichwas excised. Since then he remains well and is on regular follow up for more than 12 years from his index surgery with no evidence of disease, making himthe longest known survivor with such an advanced presentation. CONCLUSION This is an unusual instance where aggressive resection for HCC with right atrial tumor thrombus has resulted in an exceptionally long survival.
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Affiliation(s)
- Sadiq S Sikora
- Department of Surgical Gastroenterology & Liver Transplantation, Sakra World Hospital, Bangalore, India.
| | - Kishore G S Bharathy
- Department of Surgical Gastroenterology & Liver Transplantation, Sakra World Hospital, Bangalore, India
| | - Prasad Krishnan
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Prasad Babu
- Department of Surgical Gastroenterology, Yashoda Hospital, Secunderabad, India
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Sano S, Nakata S, Wada S, Kuroiwa M, Sakai H, Kusama K, Machida T, Nishio A, Ito I, Sodeyama H. Pathological complete response by advanced hepatocellular carcinoma with massive macrovascular invasion to hepatic arterial infusion chemotherapy: a case report. World J Surg Oncol 2019; 17:229. [PMID: 31878937 PMCID: PMC6933654 DOI: 10.1186/s12957-019-1772-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/17/2019] [Indexed: 02/06/2023] Open
Abstract
Background Advanced hepatocellular carcinoma (HCC) with macrovascular invasion has an extremely dismal prognosis. We report a rare case of multiple HCC with tumor thrombosis in the portal vein and inferior vena cava that was initially treated with hepatic arterial infusion chemotherapy (HAIC); later resection revealed pathological complete response. Case presentation A 75-year-old man presented with HCC in his right liver, with tumor thrombosis growing to the right portal vein and the inferior vena cava, and bilateral intrahepatic liver metastases. He underwent HAIC (5-fluorouracil [170 mg/m2] + cisplatin [7 mg/m2]) via an indwelling port. Although the tumor shrank and tumor marker levels decreased rapidly, we abandoned HAIC after one cycle because of cytopenia. We resumed HAIC 18 months later because of tumor progression, using biweekly 5-fluorouracil only [1000 mg] due to renal dysfunction. However, after 54 months, the HAIC indwelling port was occluded. The patient therefore underwent a right hepatectomy to resect the residual lesion. Histopathological findings showed complete necrosis with no viable tumor cells. The patient has been doing well without postoperative adjuvant therapy for more than 10 years after initially introducing HAIC and 6 years after the resection, without evidence of tumor recurrence. Conclusions HAIC can be an effective alternative treatment for advanced HCC with macrovascular invasion.
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Affiliation(s)
- Shusei Sano
- Department of Gastroenterological Surgery, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano-shi, Nagano, 380-8582, Japan.
| | - Shinji Nakata
- Department of Gastroenterological Surgery, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano-shi, Nagano, 380-8582, Japan
| | - Shuichi Wada
- Department of Gastroenterology, Nagano Red Cross Hospital, Nagano, Japan
| | - Masatsugu Kuroiwa
- Department of Gastroenterological Surgery, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano-shi, Nagano, 380-8582, Japan
| | - Hiroki Sakai
- Department of Gastroenterological Surgery, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano-shi, Nagano, 380-8582, Japan
| | - Kei Kusama
- Department of Gastroenterological Surgery, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano-shi, Nagano, 380-8582, Japan
| | - Taiichi Machida
- Department of Gastroenterological Surgery, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano-shi, Nagano, 380-8582, Japan
| | - Akihito Nishio
- Department of Gastroenterological Surgery, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano-shi, Nagano, 380-8582, Japan
| | - Ichiro Ito
- Department of Pathology, Nagano Red Cross Hospital, Nagano, Japan
| | - Harutsugu Sodeyama
- Department of Gastroenterological Surgery, Nagano Red Cross Hospital, 5-22-1, Wakasato, Nagano-shi, Nagano, 380-8582, Japan
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Zhang Y, Wu Z, Wang K, Han S, Li C, Li X. 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. BMC Surg 2019; 19:122. [PMID: 31455319 PMCID: PMC6712705 DOI: 10.1186/s12893-019-0568-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 07/29/2019] [Indexed: 12/12/2022] Open
Abstract
Background Presence of inferior vena cava tumor thrombosis (IVCTT) is an unfavorable factor to prognosis for patients with hepatocellular carcinoma (HCC). Case presentation Herein we report a case of HCC with IVC tumor thrombosis extending from the right hepatic vein (RHV) to the IVC, but it had not infiltrated the right atrium. Anterior approach right hepatectomy combined with IVC thrombectomy using trans-diaphragmatic IVC occlusion was performed for this patient. The patient is alive with disease-free at 32 months after treatment. A literature review was also performed. This case was demonstrated with the details and concepts of surgery. Conclusion This case suggested that surgical resection of HCC involving the IVC, but still outside the right atrium (RA), could offer satisfactory surgical outcomes in selected patients.
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Affiliation(s)
- Yaodong Zhang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China
| | - Zhengshan Wu
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China
| | - Ke Wang
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China
| | - Sheng Han
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China
| | - Changxian Li
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China
| | - Xiangcheng Li
- Hepatobiliary Center, The First Affiliated Hospital of Nanjing Medical University; Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences; NHC Key Laboratory of Living Donor Liver Transplantation, Nanjing, China.
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