title: Surgical management of hepatocellular carcinoma after Fontan procedure.
abstract: The Fontan operation has successfully prolonged the lives of patients born with single-ventricle physiology. A long-term consequence of post-Fontan elevation in systemic venous pressure and low cardiac output is chronic liver inflammation and cirrhosis, which lead to an increased risk of hepatocellular carcinoma (HCC). Surgical management of patients with post-Fontan physiology and HCC is challenging, as the requirement for adequate preload in order to sustain cardiac output conflicts with the low central venous pressure (CVP) that minimizes blood loss during hepatectomy. Consequently, liver resection is rarely performed, and most reports describe nonsurgical treatments for locoregional control of the tumors in these patients. Here, we present a multidisciplinary approach to a successful surgical resection of a HCC in a patient with Fontan physiology.
authors.affiliation: 1 Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA ; 2 Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 3 Department of Pathology, 4 Department of Anesthesiology, 5 Department of Medicine, University of Washington, Seattle, WA 98195-6410, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Kwon
authors.affiliation: 1 Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA ; 2 Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 3 Department of Pathology, 4 Department of Anesthesiology, 5 Department of Medicine, University of Washington, Seattle, WA 98195-6410, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Scovel
authors.affiliation: 1 Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA ; 2 Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 3 Department of Pathology, 4 Department of Anesthesiology, 5 Department of Medicine, University of Washington, Seattle, WA 98195-6410, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Yeh
authors.affiliation: 1 Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA ; 2 Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 3 Department of Pathology, 4 Department of Anesthesiology, 5 Department of Medicine, University of Washington, Seattle, WA 98195-6410, USA.
authors.forename: David
authors.initials: D
authors.lastname: Dorsey
authors.affiliation: 1 Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA ; 2 Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 3 Department of Pathology, 4 Department of Anesthesiology, 5 Department of Medicine, University of Washington, Seattle, WA 98195-6410, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Dembo
authors.affiliation: 1 Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA ; 2 Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 3 Department of Pathology, 4 Department of Anesthesiology, 5 Department of Medicine, University of Washington, Seattle, WA 98195-6410, USA.
authors.forename: Eric V
authors.initials: EV
authors.lastname: Krieger
authors.affiliation: 1 Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA ; 2 Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 3 Department of Pathology, 4 Department of Anesthesiology, 5 Department of Medicine, University of Washington, Seattle, WA 98195-6410, USA.
authors.forename: Ramassmy
authors.initials: R
authors.lastname: Bakthavatsalam
authors.affiliation: 1 Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA ; 2 Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 3 Department of Pathology, 4 Department of Anesthesiology, 5 Department of Medicine, University of Washington, Seattle, WA 98195-6410, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: Park
authors.affiliation: 1 Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA ; 2 Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 3 Department of Pathology, 4 Department of Anesthesiology, 5 Department of Medicine, University of Washington, Seattle, WA 98195-6410, USA.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Riggle
authors.affiliation: 1 Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA ; 2 Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 3 Department of Pathology, 4 Department of Anesthesiology, 5 Department of Medicine, University of Washington, Seattle, WA 98195-6410, USA.
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Riehle
authors.affiliation: 1 Department of Surgery, University of Washington, Seattle, WA 98195-6410, USA ; 2 Department of Surgery, Medical University of South Carolina, Charleston, SC 29425, USA ; 3 Department of Pathology, 4 Department of Anesthesiology, 5 Department of Medicine, University of Washington, Seattle, WA 98195-6410, USA.
authors.forename: Raymond S
authors.initials: RS
authors.lastname: Yeung
keywords: Fontan; Hepatocellular carcinoma (HCC); hepatectomy; resection; single ventricle