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| Combined cavo-atrial thrombectomy and hepatectomy in hepatocellular carcinoma |
| Julian Tsang, Albert Chan, Kenneth Chok, Flora Tsang and Chung Mau Lo |
Author Affiliations: Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation (Tsang J, Chan A, Chok K and Lo CM), and Division of Cardiothoracic Surgery (Tsang F), Queen Mary Hospital, University of Hong Kong, Hong Kong, China
Corresponding Author: Albert Chan, MD, Division of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Department of Surgery, Queen Mary Hospital, University of Hong Kong, Hong Kong, China (Tel: +852-22553111; Fax: +852-28165284; Email: acchan@hku.hk) |
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Abstract To the Editor:
Hepatocellular carcinoma (HCC) remains one of the commonest cancers worldwide especially in hepatitis B endemic regions. Its aggressive behavior is characterised by the natural history of increasing size, a tendency for vascular invasion into the hepatic veins and portal veins. Further growth into the inferior vena cava (IVC) and right atrium (RA) is an infrequent finding but signifies a pre-terminal event with a dismal prognosis. The reported incidence is 3%-4%.[1] Patients are at high-risk of pulmonary embolism and systemic metastasis. Surgical resection with thrombectomy offers the only chance of tumor clearance and cure. The available evidence for surgery, however, is limited with only small case series and individual case reports published.[1-4] We describe a case of HCC with IVC and RA tumor thrombus successfully treated with combined cavo-atrial thrombectomy under cardiopulmonary bypass (CPB) and hepatectomy.
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2017, Vol. 16 
