余喜多, 史郎 First Department of Surgery, The University of Tokushima School of Medicine
田代, 征記 First Department of Surgery, The University of Tokushima School of Medicine 徳島大学 教育研究者総覧
ハラダ, マサミツ First Department of Surgery, The University of Tokushima School of Medicine
北川, 哲也 Cardiovascular Surgery, The University of Tokushima School of Medicine 徳島大学 教育研究者総覧 KAKEN研究者をさがす
カトウ, イツオ Cardiovascular Surgery, The University of Tokushima School of Medicine
extension into the right atrium
total hepatic vascular exclusion
We report a successful liver resection using cardiopulmonary bypass with, total hepatic vascular exclusion (THVE) for hepatocellular carcinoma (HCC), with extension into the right atrium. A 61-year-old man with a cirrhotic liver was referred to our department with HCC in the medial segment of the left lobe of the liver, and tumor thrombus extending into the right atrium. During surgery, a left lobe and caudate lobe of the liver were transected leaving the left lobe of the liver connected to the inferior vena cava (IVC) by only the left and middle hepatic trunks, and then the intracaval tumor thrombus and the left lobe of the liver were removed en bloc using cardiopulmonary bypass with total hepatic vascular exclusion (THVE). Cardiac arrest was not performed during THVE, and the patient had an uneventful postoperative course and was discharged from the hospital 2 months following surgery. He died of multiple pulmonary metastases 4 years and 8 months after surgery;however, imaging showed no evidence of recurrence in the remnant liver during that period.
In conclusion, by performing dissection of the hepatic parenchyma to the hepatic vein prior to removal of the tumor thrombus, the period of extracorporeal circulation, duration of warm ischemic time to the liver, and intraoperative blood loss were all reduced and a radical operation could be performed safely without scattering tumor cells during extirpation of the tumor.
The journal of medical investigation : JMI
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