title: The Transmediastinal, Intrapericardial Inferior Vena Cava Approach for Hepatectomy of a Large Liver Tumor Invading the Hepatic Vein Confluence.
abstract: We report the case of a large multilocular upper liver tumor invading the hepatic vein confluence in a 41-year-old male, and the safe resection of the tumor using a transmediastinal, intrapericardial inferior vena cava (IVC) approach. Several methods for exposing suprahepatic IVCs on the cranial side of the diaphragm have been reported. However, the approach to supradiaphragmatic IVCs varies, and there are currently no reports that provide a detailed description of the anatomical landmarks during the intrapericardial IVC approach. In the case reported herein, anatomic landmarks, including the prepericardial fat in the pericardial trigone, were confirmed during the transmediastinal, intrapericardial IVC approach. We believe that such anatomic landmarks are important to ensure a safe approach to the pericardium and the intrapericardial IVC through the anterior mediastinum. We think this case report is useful in elucidating the resection of large liver tumors invading the hepatic vein confluence.
authors.forename: Taiji
authors.initials: T
authors.lastname: Tohyama
authors.forename: Kei
authors.initials: K
authors.lastname: Tamura
authors.forename: Akihiro
authors.initials: A
authors.lastname: Takai
authors.forename: Masahide
authors.initials: M
authors.lastname: Hatano
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kageyama
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Inoue
authors.forename: Jota
authors.initials: J
authors.lastname: Watanabe
authors.forename: Yasutsugu
authors.initials: Y
authors.lastname: Takada
mesh_terms: D000328:Adult; D059925:Anatomic Landmarks; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000473:pathology / Q000601:surgery*; D006801:Humans; D033162:Incidental Findings; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008482:Mediastinum / Q000601:surgery*; D064847:Multimodal Imaging / Q000379:methods; D009361:Neoplasm Invasiveness; D010496:Pericardium / Q000601:surgery*; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden; D014682:Vena Cava, Inferior / Q000601:surgery*