Extended Right Lobectomy with Extirpation of the Portal Tumor Thrombus Extending to the Main Trunk and the Left Branch for Advanced Hepatocellular Carcinoma

Abstract

The outflow for the main blood flow of hepatocellular carcinoma (HCC) is not through the hepatic vein but through the portal vein system. The abundant blood vessel networks that drain into the portal vein are located on both the inside and outside of the tumor capsule, and tumor progress via the portal vein occurs from an early stage. Therefore, it is not difficult for a tumor thrombus to form in the portal vein. Almost all patients with a tumor thrombus in the main branches of the portal vein die due to esophageal bleeding, intractable ascites, or liver failure within several months. Furthermore, conventional therapies, such as percutaneous ethanol injection, microwave coagulation therapy, and tran-scatheter arterial embolization, are generally not indicated for such patients owing to a lack of efficacy and because of possible complications. Therefore, we perform hepatic resection with the tumor thrombus. Extended right hepatic lobectomy with extirpation of the portal tumor thrombus extending to the main trunk and left branch of the portal vein was performed under ultrasound (US) in a patient with advanced hepatocellular carcinoma (HCC).