Successful curative extracorporeal hepatic resection for far-advanced hepatocellular carcinoma in an adolescent patient

✍ Scribed by Keishi Sugimachi; Ken Shirabe; Akinobu Taketomi; Yuji Soejima; Tomoharu Yoshizumi; Yo-Ichi Yamashita; Kenji Umeda; Kazutoyo Morita; Yoshihiko Maehara

• Publisher: John Wiley and Sons
• Year: 2010
• Tongue: English
• Weight: 273 KB
• Volume: 16
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.22051

✦ Synopsis

Hepatectomy is the principal treatment for hepatocellular carcinoma (HCC); however, some HCCs are not resectable by conventional hepatic resection. In such apparently incurable cases, extracorporeal hepatic resection (ECHR) may offer an option for survival. 1 We recently encountered a juvenile patient with faradvanced HCC who was successfully treated by ECHR with favorable long-term survival.

A 17-year-old woman was referred to our hospital with a huge liver mass and was admitted for evaluation. She had no history of serious illness, surgery, or hospitalization and no notable family history. Of the serum tumor markers examined, a-fetoprotein (335.5 ng/mL, normal < 20 ng/mL) and des-c-carboxy prothrombin (1988 mAU/mL, normal < 40 mAU/mL) were elevated. She was serologically negative for antihepatitis C virus antibody and hepatitis B surface antigen, but she was positive for hepatitis B core antigen.

Computed tomography with contrast enhancement showed an 18 cm  12 cm tumor in the center of the liver (Fig. 1a). One intrahepatic metastatic tumor was found in the left lateral segment of the liver. The first left branch of the portal vein was completely involved in the liver. The inferior vena cava (IVC) and the right hepatic vein (RHV) were completely surrounded by the tumor and were remarkably dislocated to the anterior side of the body (Fig. 1b,c). Celiac arterial angiography and indirect portography revealed an intact hepatic artery and the portal vein of the right posterior branch (Fig. 1d,e). The estimated remnant liver volume after