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Fifteen-year survival of a hepatocellular carcinoma extending into the right atrium treated by surgical resection with the heart-first approach under cardiopulmonary bypass: a case report and review of the literature

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Abstract

Hepatocellular carcinoma with tumor thrombus in the inferior vena cava extending into the right atrium is rare and associated with poor prognosis in most cases. Although liver resection with thrombectomy is the only curative treatment, there is no consensus on the therapeutic options for managing these rare cases. The patient was a 67-year-old man with hepatocellular carcinoma with tumor thrombus in the right atrium. In February 2003, cavo-atrial thrombectomy was first performed using cardiopulmonary bypass with heparinization and cardiac arrest. After thrombectomy, right hepatectomy was performed. The total operative time was 10 h 48 min. Moreover, the total blood loss was 7267 mL. The patient recovered uneventfully except for right pleural effusion. He was cancer-free for approximately 9 years. A new lesion in the remnant liver was detected in March 2012. He underwent transcatheter arterial chemoembolization, followed by sequential administration of sorafenib and sunitinib. Radiation therapy was also administered. Eventually, the patient expired 6 years after recurrence. Cavo-atrial thrombectomy under cardiopulmonary bypass prior to hepatectomy for hepatocellular carcinoma with tumor thrombus in the right atrium could be performed safely. Aggressive surgery with the heart-first approach and multidisciplinary treatments even after recurrence led to long-term survival.

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Abbreviations

CPB:

Cardiopulmonary bypass

HAIC:

Hepatic arterial injection chemotherapy

HCC:

Hepatocellular carcinoma

HBV:

Hepatitis B virus

ICG:

Indocyanine green

IVC:

Inferior vena cava

PV:

Portal vein

RA:

Right atrium

RATT:

Tumor thrombus in the right atrium

RFA:

Radiofrequency ablation

RHV:

Right hepatic vein

RT:

Radiotherapy

SMV:

Superior mesenteric vein

SVC:

Superior vena cava

TACE:

Transcatheter arterial chemoembolization

THVE:

Total hepatic vascular exclusion

TT:

Tumor thrombus

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Acknowledgements

The authors would like to thank Editage (www.editage.com) for English language editing.

Funding

None of the authors received any funding.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Hamamatsu Medical Center, 328 Tomitsuka-Cho, Naka-Ku, Hamamatsu, 432-8580, Japan

    Yoshiro Nishiwaki

  2. Chairman of the Board, Tokyo Midtown Clinic, 9-7-1 Akasaka, Minato-Ku, Tokyo, 107-0052, Japan

    Toshiomi Kusano

  3. Department of Cardiovascular Surgery, Hamamatsu Medical Center, 328 Tomitsuka-Cho, Naka-Ku, Hamamatsu, 432-8580, Japan

    Takane Hiraiwa

  4. Department of Pathology, Hamamatsu Medical Center, 328 Tomitsuka-Cho, Naka-Ku, Hamamatsu, 432-8580, Japan

    Takachika Ozawa

Authors
  1. Yoshiro Nishiwaki
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  4. Takachika Ozawa
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Contributions

YN, TK, and TH participated in a conference to plan for the surgery and performed it. TO performed the histological examination of the liver tumor and thrombus. YN and TK made substantial contributions to the conception and design of the article. YN, TK, TH, and TO analyzed and interpreted the data. YN was a major contributor to the writing of the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Yoshiro Nishiwaki.

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All methods were performed in accordance with the relevant guidelines and regulations including the Declaration of Helsinki,

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Written informed consent was obtained from patient’s family for publication of this case report and accompanying images because the patient is deceased.

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Nishiwaki, Y., Kusano, T., Hiraiwa, T. et al. Fifteen-year survival of a hepatocellular carcinoma extending into the right atrium treated by surgical resection with the heart-first approach under cardiopulmonary bypass: a case report and review of the literature. Clin J Gastroenterol 17, 118–129 (2024). https://doi.org/10.1007/s12328-023-01874-y

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