Tumor Thrombus Removal with Hepatic Resection Using Cardiopulmonary Bypass in a Patient with Hepatocellular Carcinoma Extending into Right Atrium

Hiroyuki Sugimoto, Soichiro Inoue, Toshiaki Mori, Masashi Hirota, Shin Takeda, Tetsuya Kaneko and Akimasa Nakao

Gastroenterological Surgery, Nagoya University Graduate School of Medicine

Most patients with hepatocellular carcinoma and tumor thrombus extending into the right atrium die soon. Tumor thrombus removal without hepatic resection has been done to prevent sudden death due to pulmonary embolization or heart failure, but the ensuing prognosis is generally poor. Some reports have recently detailed hepatic resection with removal of the tumor thrombus. We report a patient with hepatocellular carcinoma and tumor thrombus extending into the right atrium. The patient underwent hepatectomy with removal of the tumor thrombus and was discharged early postoperatively without complications. Tumor thrombus removal with hepatic resection using cardiopulmonary bypass has been done in only 7 cases with hepatocellular carcinoma extending into the right atrium in Japan, and problems with surgical indications and procedures have arisen. We conducted thrombectomy under cardiopulmonary bypass before hepatic resection. Here we report the adequacy of surgical indications and procedures together with a review of the literature.

Key words
hepatocellular carcinoma, intraatrial tumor thrombus, extracorporeal circulation

Reprint requests
Hiroyuki Sugimoto Gastroenterological Surgery, Nagoya University Graduate School of Medicine
65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550 JAPAN

Accepted
April 28, 2004

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