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Review
. 2019 Aug 28;19(1):122.
doi: 10.1186/s12893-019-0568-7.

Long-term survival after anterior approach right hepatectomy combined with inferior vena cava thrombectomy using trans-diaphragmatic intrapericardial inferior vena cava occlusion: a case report and review of the literature

Yaodong Zhang  1 , Zhengshan Wu  1 , Ke Wang  1 , Sheng Han  1 , Changxian Li  1 , Xiangcheng Li  2
Affiliations
Review

Long-term survival after anterior approach right hepatectomy combined with inferior vena cava thrombectomy using trans-diaphragmatic intrapericardial inferior vena cava occlusion: a case report and review of the literature

Yaodong Zhang et al. BMC Surg. .

Abstract

Background: Presence of inferior vena cava tumor thrombosis (IVCTT) is an unfavorable factor to prognosis for patients with hepatocellular carcinoma (HCC).

Case presentation: Herein we report a case of HCC with IVC tumor thrombosis extending from the right hepatic vein (RHV) to the IVC, but it had not infiltrated the right atrium. Anterior approach right hepatectomy combined with IVC thrombectomy using trans-diaphragmatic IVC occlusion was performed for this patient. The patient is alive with disease-free at 32 months after treatment. A literature review was also performed. This case was demonstrated with the details and concepts of surgery.

Conclusion: This case suggested that surgical resection of HCC involving the IVC, but still outside the right atrium (RA), could offer satisfactory surgical outcomes in selected patients.

Keywords: Hepatocellular carcinoma; Inferior vena cava; Tumor thrombosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a CT scan showing a huge HCC located in the right hepatic lobe with tumor thrombus (arrow) entering the IVC. b Coronal CT suggests IVTT had passed the diaphragm level, but had not enter the right atrium (arrow). c Anterior approach right hepatectomy combined with IVCTT thrombectomy
Fig. 2
Fig. 2
a Ligation of the right hepatic artery and portal vein. b The suprarenal IVC and portal vein were dissected and encircled (arrow). c The supradiaphragmatic IVC was encircled through a vertical incision of the diaphragm (arrow). d The sequence of total hepatic vascular exclusion: ① Suprarenal IVC ② The portal vein ③ Supradiaphragmatic IVC ④ Retrohepatic IVC
Fig. 3
Fig. 3
a The resected tumor specimens. b Hepatocellular carcinoma, II-III, giant size, size 10 × 11 × 13 cm, visible intravascular tumor thrombus, incision without tumor residual (HE staining, × 400). c CT examinations and laboratory results of AFP showed no signs of recurrence or metastasis 32 months after the surgery
Fig. 4
Fig. 4
IVCTT-presenting HCC is classified into three types. a The TT located within the subdiaphragmatic IVC; b The IVCTT extended above the diaphragm, but it had not infiltrated the RA; and (c) The TT extended over the diaphragm and had advanced into the RA
See this image and copyright information in PMC

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