title: Aggressive surgical resection for hepatocellular carcinoma with tumor thrombus extending to inferior vena cava and synchronous pulmonary metastasis.
abstract: We describe a 66-year-old man having hepatocellular carcinoma with tumor thrombus extending into the inferior vena cava and synchronous pulmonary metastasis. He was referred to Chiba University Hospital on May, 2000, complaining of emaciation. Radiological findings showed a huge hepatocellular carcinoma in the entire right lobe and tumor thrombus extended into the intrapericardial inferior vena cava. He also had a solitary pulmonary metastasis in the left pulmonary lobe (stage IVB). Right hemihepatomy was performed under total hepatic vascular exclusion without cardiopulmonary bypass, and tumor thrombus was completely removed. Thoracoscopic wedge resection of pulmonary metastasis was also performed. The patient had an uneventful postoperative course. Histopathological examination revealed that the tumor was moderately differentiated hepatocellular carcinoma The patient is still alive after 26 months with pulmonary recurrence, but without hepatic recurrence. To our knowledge, there has been no reported case of resection for both hepatocellular carcinoma invading the inferior vena cava and synchronous pulmonary metastasis. In conclusion, aggressive surgical resection for advanced hepatocellular carcinoma concomitant with pulmonary resection may bring about better prognosis in highly selected patients.
authors.affiliation: Department of General Surgery, Chiba University Graduate School of Medicine, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kitayama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshidome
authors.forename: Noboru
authors.initials: N
authors.lastname: Mitsuhashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ito
authors.forename: Fumio
authors.initials: F
authors.lastname: Kimura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Shimizu
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohtsuka
authors.forename: Masaru
authors.initials: M
authors.lastname: Miyazaki
mesh_terms: D000368:Aged; D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D006498:Hepatectomy; D006503:Hepatic Veins / Q000473:pathology / Q000601:surgery; D006801:Humans; D008099:Liver / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008168:Lung / Q000473:pathology; D008175:Lung Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009367:Neoplasm Staging; D009360:Neoplastic Cells, Circulating; D011013:Pneumonectomy; D013906:Thoracoscopy; D014057:Tomography, X-Ray Computed; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*