title: [Sustained complete remission with reductive surgery plus percutaneous isolated hepatic perfusion (PIHP) for bilobar multiple hepatocellular carcinoma with portal venous tumor thrombus--a case report].
abstract: For patients with multiple bilobar hepatocellular carcinoma (m-HCC) and/or advanced portal venous tumor thrombus (Vp3, 4), there has been no effective therapy, and the survival of more than 6 months was exceptional. Under these circumstances, we have developed a dual treatment (dual Tx) that combines reductive hepatectomy with percutaneous isolated hepatic perfusion (PIHP) for such patients. This dual Tx offers the high-rate of mid- and long-term survival in a subset of patients who had previously a dismal prognosis. Herein, we report a patient with Vp4 m-HCC who was successfully treated with dual Tx and survived for more than 2 years with a complete remission of hepatic tumors. A 53-year-old man had main tumors in the right lobe liver and multiple bilobar intrahepatic metastases (IM) with portal venous tumor thrombus reaching the portal trunk. He underwent an extended right hepatectomy with portal venous tumor thrombectomy, and subsequently PIHP twice in a 3-month period after reductive hepatectomy. After dual Tx, he had sustained complete remission for more than 2 years. He died because of obstruction of the superior vena cava by recurrent tumors in the mediastinum. His clinical course after treatment strongly indicates that the dual Tx should become a major treatment option for patients with Vp3, 4 m-HCC.
authors.affiliation: Liver and Transplantation Surgery, Kobe University Hospital.
authors.forename: Motofumi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tominaga
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iwasaki
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Nobuya
authors.initials: N
authors.lastname: Kusunoki
authors.forename: Takemi
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Shinobu
authors.initials: S
authors.lastname: Tsuchida
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kido
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takebe
authors.forename: Hisoka
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Yonson
authors.initials: Y
authors.lastname: Ku
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating / Q000473:pathology*; D011169:Portal Vein / Q000473:pathology*; D012074:Remission Induction