A Case Report of Surgical Treatment for Patient with Tumor Thrombus of Renal Cell Carcinoma Extending to the Retrohepatic Vena Cava under the Technique of Partial Extracorporeal Circulation and Hypothermic Perfusion of the Liver

Tadatoshi Ohe, Arimichi Takabayashi, Yuuji Usui, Hirokazu Jyujyo, Atsuhiko Maki, Katsumi Takeuchi

Department of Surgery Kitano Hospital, Tazukekoufukai Medical Research Institute

Extended hepatic surgery and hepatic transplantation under total vasuclar exclusion technique has been established. We applied this technique to a patient with tumor thrombus extending to the retrohepatic vena cava and arising from advanced renal cell carcinoma. After left nephrectomy, we carried out thrombectomy under total hepatic vascular exclusion with partial extracorporeal circulation using a Bio-pump^® (BP-80), because the tumor thrombus reached the level of the main hepatic outlet. In addition, hypothermic perfusion of the liver using 1000 ml of Lactate Ringer solution at 4°C was performed to preserve liver function. Total ischemic time of the liver was 36 minutes. The duration of the critical level of arterial ketone body ratio (<0.4) was 30 minutes during this operation. Serum GOT and GPT levels rose to 255 and 170 KU on the first postoperative day and returned to normal by the 14th postoperative day. Extensive tumor thrombus in the inferior vena cava could be removed safely without any additinal damage to the liver under partial extracorporeal circulationand the hypothermic perfusion technique.

Key words
tumor thrombus extending to inferior vena cava, Bio-pump^®, hypothermic perfusion of the liver

Reprint requests
Tadatoshi Ohe Department of Surgery, Rakuwakai Otowa Hospital
2 Otowachinjichou, Yamashinaku, Kyoto, 607 JAPAN

Accepted
November 9, 1994

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