Surgical treatment after hepatic arterial infusion chemotherapy for hepatocellular carcinoma extending into the right atrium.

Shintaro Kurahashi,Seiji Natsume,Yasuhiro Shimizu,Hidekazu Yamaura,Tsuyoshi Sano,Yoshiki Senda,Yoshitaka Inaba

doi:10.1186/s40792-015-0047-z

Abstract

A resected case of hepatocellular carcinoma which extended into the right atrium after treatment with hepatic arterial infusion chemotherapy (HAIC) is described. An 81-year-old man presented with right hypochondralgia. CT demonstrated a hypervascular tumor 11.5 cm in diameter extending into the right atrium through the right hepatic vein. The patient underwent HAIC with 100 mg of cisplatin (CDDP IA-call®) particles three times every month. The tumor showed a marked shrinkage and an involution of the venous thrombus around the orifice of the right hepatic vein. Right hemihepatectomy with tumor thrombectomy was performed as a salvage surgery using a total hepatic vascular exclusion technique. Histologically, the tumor turned into diffuse necrosis and fibrosis, so viable tumor cells were encountered neither in the main tumor nor venous thrombus. The therapeutic effect of HAIC was pathological complete remission. The patient has been doing well for 6 years after the surgery without evidence of tumor recurrence. The salvage operation was safely achievable for the initially unresectable advanced hepatocellular carcinoma extending into the right atrium.

Highlights

Hepatectomy for a hepatocellular carcinoma with a hepatic venous tumor thrombus extending into the right atrium (HCC-RA thrombus) is a rare surgical indication for cure
We describe an aggressively resected case of HCC-RA thrombus after treatment with hepatic arterial infusion chemotherapy (HAIC) using cisplatin particles, and the patient survives more than 6 years without a tumor recurrence
Compared with portal venous tumor thrombus, hepatic venous tumor thrombus (HVT) extending into the inferior vena cava (IVC) or right atrium is rare; it is reported in 6 % of antemortem HCC with vascular invasions [12]

Summary

Background

Hepatectomy for a hepatocellular carcinoma with a hepatic venous tumor thrombus extending into the right atrium (HCC-RA thrombus) is a rare surgical indication for cure. We describe an aggressively resected case of HCC-RA thrombus after treatment with hepatic arterial infusion chemotherapy (HAIC) using cisplatin particles, and the patient survives more than 6 years without a tumor recurrence. CT during arterial portography demonstrated hypoperfusion in the entire caudate lobe, reflecting congestion of the inferior vena cava (IVC) due to the tumor thrombus (Fig. 1c) The diagnosis for this patient was HCC-RA thrombus. The patient underwent HAIC with 100 mg of cisplatin (CDDP IA-call®) particles in 20 min via the right hepatic artery three times every month. Both AFP and DCP decreased to within the normal range after the second HAIC session. Without an additional oncologic treatment after surgery until now, the patient has been alive with no recurrence for 6 years

Discussion

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Conclusions