A Case Report of Hepatectomy under Extracorporeal Circulation for Hepatocellular Carcinoma with Portal and Caval Tumor Thrombus

We performed a right hepatectomy and a tumor thrombectomy by partially resecting the inferior vena cava and the portal vein under extracorporeal circulation using the Bio-Pump on a patient with hepatocellular carcinoma, in whom there were tumor thrombi in the inferior vena cava and the portal vein. It might have been possible to operate by just clamping the inferior vena cava below the hepatic vein without extracorporeal circulation, as the tumor thrombus in the inferior vena cava was developed through a short hepatic vein. However, we decided to operate under extracorporeal circulation, because we thought it would be safer to take enough time to observe the extension of the vascular invasion of tumor closely, and to reconstruct the vein. Although the patient recovered without any problem after the operation, she died of recurrence of the carcinoma 4 months after surgery. On autopsy multiple recurrent tumors were found in the remnant liver, but there was no metastasis to other organs. In this kind of case of advanced hepatocellular carcinoma with tumor thrombi we think the patient should be protected by supplemental therapy such as transcatheteric hepatic arterial embolization or combination chemotherapy even in the early postoperative period.