Surgical management of hepatic vein occlusion by tumor: Budd-Chiari syndrome.
We report new operative approaches to the treatment of hepatic vein occlusion due to malignant tumors in the liver and their results in four patients. Two patients had hepatoma, one had metastatic melanoma, and one had metastatic leiomyosarcoma. All of them had abdominal pain, abdominal distention secondary to ascites, and massive hepatomegaly. The right lobe and medial segment of the left lobe of the liver were involved in three patients, and the involvement was diffuse throughout the liver in one. Hepatic veins were occluded completely in one patient, and two of three veins were occluded in the others. Two patients were treated by hepatic resection and removal of tumor thrombus from the hepatic vein under isolation-perfusion technique. They lived 18 and six months, respectively, without recurrence of Budd-Chiari syndrome. Tumors in the other patients were diffuse and could not be resected. The hepatic artery was ligated and chemotherapy was given postoperatively. Ascites and abdominal pain disappeared completely in one, who survived 17 months. The other patient had significant palliation and lived nine months.
D000970:Antineoplastic Agents / Q000008:administration & dosage; D006502:Budd-Chiari Syndrome / Q000601:surgery*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery; D010478:Chemotherapy, Cancer, Regional Perfusion; D006498:Hepatectomy; D006801:Humans; D007890:Leiomyosarcoma / Q000150:complications / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications* / Q000601:surgery; D008545:Melanoma / Q000150:complications / Q000601:surgery; D008722:Methods; D009362:Neoplasm Metastasis; D012008:Recurrence
D000970:Antineoplastic Agents