Cavo-atrial thrombectomy combined with left hemi-hepatectomy for vascular invasion from hepatocellular carcinoma on diseased liver under hypothermic cardio-circulatory arrest.
Vascular invasion of supra-hepatic veins (SHV) is a major complication of primary liver tumours. The tumorous thrombus, when extended to the vena cava and right atrium, may produce occlusion of the tricuspid valve or pulmonary embolism with sudden cardiac death. The presence of macroscopic vascular infiltration represents an advanced stage of the tumour contraindicating liver transplantation, thus liver resection with thrombectomy is the only therapeutic option in this setting despite the concerns of postoperative liver failure and the dismal results at distance. A 45-year-old male with chronic active hepatitis/cirrhosis was referred to our department for a tumour in the left hemi-liver with infiltration of the left-middle hepatic veins and a tumour thrombus extension to the right atrium. We reported a successful cavo-atrial thrombectomy, along with left hemi-hepatectomy, under hypothermic cardio-circulatory arrest (HCA). To our knowledge, this technique has been used only once for primary liver cancer on chronic liver disease, this being the second case reported in literature. We conclude that this technique should be considered for atrial thrombi removal in patients affected by liver tumours in the presence of a healthy liver or of a well compensated liver cirrhosis in order to prolong the patient's life span.
Leo
Francesca
F
Unità di Chirurgia dell'Apparato Digerente, Università degli Studi di Firenze, Azienda Ospedaliero-Universitaria di Careggi, Viale Morgagni 85, Florence, Italy.
Rapisarda
Fabio
F
Stefano
Pier Luigi
PL
Batignani
Giacomo
G
D019917:Blood Vessel Prosthesis Implantation; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery* / Q000821:virology; D006324:Heart Arrest, Induced; D006325:Heart Atria / Q000473:pathology / Q000601:surgery; D006498:Hepatectomy; D006503:Hepatic Veins / Q000473:pathology / Q000601:surgery; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D007036:Hypothermia, Induced; D008103:Liver Cirrhosis / Q000821:virology; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D017131:Thrombectomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014684:Venae Cavae / Q000473:pathology / Q000601:surgery*