title: [A case of multiple hepatocellular carcinoma with rapidly progressing bilateral portal vein tumor thrombosis--a complete remission achieved with dual treatment of reductive surgery plus percutaneous isolated hepatic perfusion].
abstract: We herein report a case of multiple advanced hepatocellular carcinoma (HCC) with rapidly progressing portal vein tumor thrombosis (PVTT). All of the hepatic tumors have completely disappeared for more than two years by a dual treatment with reductive surgery plus percutaneous isolated hepatic perfusion (PIHP). A 55-year-old man was referred to our institution on June 30, 2003. The abdominal CT scan demonstrated multiple massive HCC in the entire liver with PVTT reaching the portal trunk (Vp4). Two weeks later, the PVTT rapidly progressed to the umbilical portion of the left portal vein, and to the confluence of the superior mesenteric vein and to the splenic vein. Thus, we semi electively performed an extended right hepatectomy together with thrombectomy of the PVTT. Subsequently, he underwent a repeated PIHP (1st; doxorubicin 90 mg/m2, 2nd doxorubicin 65 mg/m2). This treatment produced complete tumor clearance of all of the residual tumors in the left liver. In March 2005, he underwent partial pneumonectomy for a metastatic lung. This again resulted in normalization of serum AFP and PIVKA-II levels. Dual treatment is considered to be the strongest therapeutic modality for multiple advanced HCC with severe PVTT. In addition, a close follow-up is required because in such far advanced cases, metastatic lesions most likely recur in the liver but also in the distant organs.
authors.affiliation: Dept of Liver and Transplantation Surgery, Kobe University Hospital.
authors.forename: Shinobu
authors.initials: S
authors.lastname: Tsuchida
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukumoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tominaga
authors.forename: Takeshi
authors.initials: T
authors.lastname: Iwasaki
authors.forename: Nobuya
authors.initials: N
authors.lastname: Kusunoki
authors.forename: Takemi
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kido
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takebe
authors.forename: Motofumi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Kinoshita
authors.initials: K
authors.lastname: Hisoka
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; D018450:Disease Progression; 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; D017131:Thrombectomy