Concomitant Hepatectomy and Atrial Thrombectomy under Cardiopulmonary Bypass versus Staged Hepatectomy in the Treatment for Hepatocellular Carcinoma with Large Right Atrial Tumor Thrombi

Abstract

(1) Background: Hepatocellular carcinoma (HCC) with a large right atrium tumor thrombus (RATT) is a rare and critical presentation. Emergency hepatectomy and thrombectomy under cardiopulmonary bypass (CPB) is life-saving and potentially curative. The aim of this study is to propose an appropriate approach for this condition. (2) Methods: In period A (1998 to 2010, n = 7), hepatectomy and thrombectomy were concomitantly performed, and staged hepatectomy was performed in period B (2011 to 2018, n = 17). (3) Results: The median overall survival time (MOST) in the published studies was 14 months. Moreover, the blood loss, blood transfusion rate, length of ICU stays, and hospital costs were significantly reduced in period B. The MOSTs of patients in period A (n = 6) and period B (n = 17) were 14 vs. 18 months (p = 0.099). The median disease-free survival times (MDFTs) in period A (n = 6) and period B (n = 15) were 8 vs. 14 months (p = 0.073), while the MOSTs in period A and period B were 14 vs. 24 months (p = 0.040). (4) Conclusions: Emergency thrombectomy under CPB and staged hepatectomy 4–6 weeks later may be an appropriate approach for HCC with large RATT. However, the optimal waiting interval requires further investigation.

Uncommon using of the pulmonary homograft in oncological case - three years follow up

“…However, it is not fully known what period should be between the stages. Also, the authors do not indicate whether they stop the heart or not, apply hypothermia or not [8]. Laquaglia et al demonstrate how with technical difficulties, an ex vivo hemihepatectomy can be performed in CPB [9].…”

Efficacy of TACE Combined with Lenvatinib Plus Sintilimab for Hepatocellular Carcinoma with Tumor Thrombus in the Inferior Vena Cava and/or Right Atrium

“…5,6 Patients with tumor thrombus invading the IVC or RA, often accompanied by PVTT, have an extremely poor prognosis since the pulmonary embolization and massive involvement of the right atrial cavity can rapidly lead to death with a median survival of about 2-5 months in untreated patients. 7 Surgery, transarterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), radiotherapy (RT), high-intensity focused ultrasound (HIFU), radiofrequency ablation (RFA), and microwave ablation (MWA) are the most common treatment methods for patients with IVC or RA TT. [8][9][10] Because of the macrovascular invasion, these patients are classified as Barcelona Clinic Liver Cancer (BCLC) stage C, for which the tyrosine kinase inhibitor (TKI), sorafenib or lenvatinib, is recommended as the standard therapy.…”