title: Cavoatrial thrombectomy in hepatocellular carcinoma with tumor thrombus in the vena cava and atrium without the use of cardiopulmonary bypass.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) with tumor thrombus (TT) in hepatic vein, inferior vena cava (IVC), and right atrium (RA) portends a poor prognosis because of intravascular extension leading to rapid distal metastases. En bloc resection of cavoatrial TT without the use of cardiopulmonary bypass (CPB) is challenging. We describe a new method of vascular occlusion for thrombus entering into the RA without the need for CPB as shown in echocardiography.
  
  
  RESULTS
  Retrospective analysis was carried out in 1 HCC patient, who had undergone hepatectomy with TT extension into IVC and RA. The infrahepatic IVC was occluded with vascular tape and the right atrial appendage was controlled with a Satinsky clamp proximal to the TT. The IVC wall was incised under direct vision from the infrahepatic IVC cranially. The tumor and thrombus were then removed en bloc under direct vision. Thus, cavoatrial thrombectomy was performed under total hepatic vascular exclusion without the use of CPB. He survived for 6 months and died of tumor recurrence.
  
  
  CONCLUSIONS
  Using this technique, advanced HCC with cavoatrial TT can be resected safely without CPB and thereby avoid dislodgement of TT and air embolism.
authors.affiliation: Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China. Electronic address: ajli62@gmail.com.
authors.forename: Ai-Jun
authors.initials: AJ
authors.lastname: Li
authors.affiliation: Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China.
authors.forename: Hang
authors.initials: H
authors.lastname: Yuan
authors.affiliation: Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Yin
authors.affiliation: Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Che
authors.affiliation: Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China.
authors.forename: Xi-Long
authors.initials: XL
authors.lastname: Lang
authors.affiliation: Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, 225 Changhai Road, Shanghai, China.
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D017809:Fatal Outcome; D006325:Heart Atria / Q000473:pathology / Q000601:surgery*; D006331:Heart Diseases / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D009361:Neoplasm Invasiveness; D017131:Thrombectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D020246:Venous Thrombosis / Q000473:pathology / Q000601:surgery*