Published online Dec 26, 2021. doi: 10.12998/wjcc.v9.i36.11495
Peer-review started: August 19, 2021
First decision: September 5, 2021
Revised: September 25, 2021
Accepted: November 14, 2021
Article in press: November 14, 2021
Published online: December 26, 2021
Hepatocellular carcinoma (HCC) accompanied by a tumor thrombus is very common. However, the treatment strategy is controversial and varies by the location of the thrombus.
We report herein a case of HCC with a tumor thrombus in the suprahepatic inferior vena cava (IVC), which was successfully treated by hepatectomy combined with thrombectomy following sorafenib chemotherapy. A 47-year-old woman with chronic hepatitis was diagnosed with HCC. Computed tomography and magnetic resonance imaging showed that the tumor lesion was located in the right half of the liver, and a tumor thrombus was detected in the suprahepatic IVC near the right atrium. After multi-departmental discussion and patient informed consent, right major hepatectomy and total removal of the tumor thrombus were successfully performed under cardiopulmonary bypass. There were no serious complications after surgery. Following sorafenib treatment, no recurrence has been detected so far (11 mo later).
Surgical treatment followed by adjuvant sorafenib therapy might be an acceptable choice for HCC patients with tumor thrombosis in the IVC.
Core Tip: Hepatocellular carcinoma (HCC) is the most common type of liver cancer with a high mortality rate worldwide. For HCC patients with tumor thrombosis in the inferior vena cava (IVC), in addition to tumor progression, acute pulmonary embolism induced by tumor thrombosis is also a vital factor decreasing patient survival. Once a pulmonary embolism occurs, there is no effective therapy, and the patients usually die. Therefore, in Asia-Pacific regions such as China, Japan and South Korea, surgical treatment is recommended in highly selected patients, which might provide better survival outcomes than other treatments. Here, we report a case of a resectable HCC patient with tumor thrombosis in the IVC who was treated successfully by liver resection, tumor thrombosis removal and systemic treatment.