Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report

Kei Shibuya,Ryo Muranushi,Ken Shirabe,Norifumi Harimoto,Mariko Tsukagoshi,Masaya Miyazaki,Kouki Hoshino,Takamichi Igarashi,Kenichiro Araki,Norihiro Ishii,Hirofumi Kawanaka,Akira Watanabe,Norio Kubo,Kei Hagiwara

doi:10.1186/s40792-020-00952-4

Abstract

BackgroundLiver cirrhosis occurs in approximately 80–90% of patients with hepatocellular carcinoma (HCC), and hepatic resection may be dangerous because of well-documented liver cirrhosis, which may be accompanied by portal hypertension (PH). Here we report a patient with advanced HCC with gastric varices and PH who experienced a good clinical course after undergoing balloon-occluded retrograde transvenous obliteration (BRTO), percutaneous transhepatic portal vein embolization (PTPE), hand-assisted laparoscopic (HALS) splenectomy, and right lobectomy of the liver.Case presentationA 72-year-old man had two HCCs with gastric varices. CT revealed one tumor (4.5 cm) located in segment 7, involving the right hepatic vein, adjacent to the middle hepatic vein. Another tumor (2.7 cm) was located in segment 6. He first underwent BRTO for gastric varices and PTPE for planned right lobectomy of the liver. To reduce PH, HALS splenectomy was performed, and uncomplicated right lobectomy of the liver was performed 10 weeks after the first visit. He has remained free of recurrence for at least 1 year.ConclusionsOur patient underwent uncomplicated BRTO, PTPE, HALS splenectomy, and right lobectomy of the liver for advanced HCC with PH. Controlling portal pressure is important when hepatic resection is required to treat HCC with PH.

Highlights

Liver cirrhosis occurs in approximately 80–90% of patients with hepatocellular carcinoma (HCC), and hepatic resection may be dangerous because of well-documented liver cirrhosis, which may be accompanied by portal hypertension (PH)
Liver cirrhosis occurs in approximately 80–90% of patients with HCC, and hepatic resection tends to be dangerous because of liver cirrhosis [2, 3] if patients with liver cirrhosis have
We report a patient with a good clinical course who underwent balloon-occluded retrograde transvenous obliteration (BRTO), percutaneous transhepatic portal vein embolization (PTPE), hand-assisted laparoscopic (HALS) splenectomy, and right lobectomy of the liver for advanced HCC with PH

Summary

Conclusions

Our experience with the present patient who underwent multiple procedures to treat advanced HCC with PH provides compelling evidence that controlling PVP is important when the hepatic resection is required for treating this condition.

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