title: Surgery for hepatocellular carcinoma with tumor thrombus extending into the right atrium: report of a successful resection without the use of cardiopulmonary bypass.
abstract: Hepatocellular carcinomas, of which the tumor thrombus extends into the right atrium via the inferior vena cava, may soon cause fatal complications. Only surgery can be an effective treatment. This procedure usually needs the aid of cardiopulmonary bypass. We recently experienced a successful surgery to remove thrombus combined with hepatectomy. Reporting the detailed technique, both associated diagnosis and intraoperative management are discussed herein. We were able to perform hepatectomy of tumor thrombus in the right atrium without the use of cardiopulmonary bypass or veno-venous bypass. The tumor thrombus was removed from the right atrium into the suprahepatic inferior vena cava by reducing the liver on the tail side. And after total hepatic vascular exclusion was achieved, the intracaval tumor thrombus and the right lobe of the liver were removed en bloc. The operation took 545 minutes and the total hepatic vascular exclusion period was 32 minutes. The postoperative course was uneventful. There are some key points for this procedure. Preoperative or intraoperative US is essential in judging whether tumor thrombus can be removed from the right atrium into the inferior vena cava by reducing the liver or not. Test clamping of the inferior vena cava prior to total hepatic vascular exclusion will enable us to judge whether veno-venous bypass during total hepatic vascular exclusion is needed or not. Surgery without the use of cardiopulmonary bypass is safe and can be minimally invasive when it is performed with a reliable diagnosis and technique.
authors.affiliation: Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Mamoru
authors.initials: M
authors.lastname: Uemura
authors.forename: Yo
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Terumasa
authors.initials: T
authors.lastname: Yamada
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Eguchi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Ohigashi
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Doki
authors.forename: Kohei
authors.initials: K
authors.lastname: Murata
authors.forename: Isao
authors.initials: I
authors.lastname: Miyashiro
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takami
authors.forename: Toru
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Shingi
authors.initials: S
authors.lastname: Imaoka
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D006325:Heart Atria / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D011172:Portography; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery