title: A novel technique for resection of huge right lobe hepatocellular carcinoma extending to the right atrium: in-situ cold perfusion of liver.
abstract: OBJECTIVE
  Surgery for advanced hepatocellular carcinoma with inferior vena cava or right atrium extension represents challenging procedures for hepatobiliary surgeons. Regardless of the surgical approach chosen, the liver parenchyma inevitably has to suffer from ischemia during the total hepatic vascular exclusion period.
  
  
  METHODS
  We report our novel technique for resection of a huge hepatocellular carcinoma extending to the right atrium. During the total hepatic vascular exclusion period, in-situ cold perfusion of the liver was performed in order to minimize the ischemic insults.
  
  
  RESULTS
  The 53-year-old male patient with chronic hepatitis B was diagnosed to have a huge right lobe hepatocellular carcinoma, besides which the tumor had invaded the right hepatic vein and right atrium. With the help of cardio-pulmonary bypass and in-situ cold perfusion of the liver, the tumor was removed en-bloc. The operating time was 458 minutes. The cold ischemia time of the liver was 53 minutes 30 seconds. The cardio-pulmonary bypass time was 61 minutes. The estimated blood loss was about 7000 ml. The patient was discharged under stable condition on postoperative day 35.
  
  
  CONCLUSIONS
  In selected patients, when the expected tumor resection time is long, the in-situ cold perfusion of the liver could be considered an option.
authors.forename: Chia-Cheng
authors.initials: CC
authors.lastname: Lin
authors.forename: Kuo-Hua
authors.initials: KH
authors.lastname: Lin
authors.forename: Yu-Ju
authors.initials: YJ
authors.lastname: Hung
authors.forename: Yao-Li
authors.initials: YL
authors.lastname: Chen
mesh_terms: D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D050377:Cold Ischemia; D003080:Cold Temperature; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D061646:Operative Time; D010477:Perfusion / Q000379:methods*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden