Hepatocellular carcinoma on cirrhosis complicated with tumoral thrombi extended to the right atrium: results in three cases treated with major hepatectomy and thrombectomy under hypothermic cardiocirculatory arrest and literature review

Pesi, Benedetta; Giudici, Francesco; Moraldi, Luca; Montesi, Gianfranco; Romagnoli, Stefano; Pinelli, Fulvio; Stefàno, Pierluigi; Batignani, Giacomo

doi:10.1186/s12957-016-0831-7

Cited by 22 publications

(23 citation statements)

References 25 publications

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“…If HCC with a tumor thrombus in the IVC and RA is found during the end stage, the prognosis is very poor. If not treated, the survival time is between three days and two months . Our patient survived only 43 days after admission.…”

Section: Discussionmentioning

confidence: 78%

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Hepatocellular carcinoma with inferior vena cava and right atrial tumor thrombus: A case report

2019

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This is a case report of a 45-year-old patient admitted with the symptom of bilateral leg swelling. Ultrasonography revealed a hyperechoic mass in the right lobe of the liver, which invaded the right hepatic vein (RHV) and extended into the inferior vena cava (IVC) and right atrium (RA). Based on the high alpha-fetoprotein (AFP) level and the ultrasonography findings, the patient was diagnosed as having hepatocellular carcinoma (HCC) with a RHV, IVC, and RA tumor thrombus and secondary Budd-Chiari syndrome (BCS). HCC with a tumor thrombus extending into the IVC and RA has rarely been observed, and as a cause of secondary BCS, this type of HCC has been even more rarely reported. K E Y W O R D S hepatocellular carcinoma, inferior vena cava, right atrium, tumor thrombus S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. Movie S1. Transthoracic echocardiography, apical 4-chamber view, revealed a thrombus (yellow arrow) in the RA. RA = right atrium; RV = right ventricle; LA = left atrium; LV = left ventricle; TT = tumor thrombus; IVC = inferior vena cava. Movie S2. Transthoracic echocardiography showed the TT in the RA coming from the IVC and the thrombus in the RHV and IVC (red arrow). RA = right atrium; RV = right ventricle; TT = tumor thrombus; IVC = inferior vena cava; RHV = right hepatic vein. Movie S3. Abdominal ultrasound showed the TT coming from the IVC (red arrow) and integrating with the liver mass (white arrow). LV = left ventricle; RV = right ventricle; TT = tumor thrombus; IVC = inferior vena cava. Movie S4. Transthoracic echocardiography showed that the tumor thrombus in the RHV, IVC (red arrow) and RA was continuous. RA = right atrium; RV = right ventricle; TT = tumor thrombus; IVC = inferior vena cava; RHV = right hepatic vein. How to cite this article: Chen M, Huang X, Yang Q. Hepatocellular carcinoma with inferior vena cava and right atrial tumor thrombus: A case report. Echocardiography.

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Section: Discussionmentioning

confidence: 78%

“…Hepatocellular carcinoma is the third most common cause of cancer‐related death worldwide . HCC often causes portal vein tumor thrombus formation, with metastasis to the liver, lungs, and other organs, while direct invasion of the hepatic vein and formation of a tumor thrombus extending into the IVC and RA is relatively rare.…”

Section: Introductionmentioning

confidence: 99%

Hepatocellular carcinoma with inferior vena cava and right atrial tumor thrombus: A case report

2019

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“…However, higher values of indocyanine green clearance are not an absolute surgical contraindication as for the possible clearance impairment by tumor-related vascular obstruction [57]. Pesi et al [35] summarized that RA tumor thrombus removal could be performed in three ways: 1) with the use of THVE of the liver without CPB, which is indicated for tumor thrombi with an initial contiguity to the RA; 2) normothermic CPB with THVE; and 3) CPB with hypothermic circulatory arrest, but its use is limited due to potentially intraoperative bleeding, possible brain damage and postoperative liver dysfunction. Wang et al [3] reported that they performed cavoatrial thrombectomy for HCC patients with RA thrombus by modifying procedures as minimally invasive as possible depending on the extension of the tumor thrombus.…”

Section: Discussionmentioning

confidence: 99%

“…The timing of diagnosis of RA thrombi was described for 53 patients: at HCC recurrence in 5 (9.4%) patients [1,5,13,15,30], at HCC progression in 13 (24.5%) patients [1, 17, 19, 34, 36-38, 40, 42, 48, 51], and at the first HCC diagnosis in 35 The size of liver tumor was described for 57 patients. The calculated tumor size was 8.4±4.1 (range, 1.3-21; median, 7.6) cm, with only 3 (5.3%) tumors of 3 patients <3 cm [1,6,51].…”

Section: Patient Characteristicsmentioning

confidence: 99%

Hepatocellular carcinoma with right atrial tumor thrombus: a systematic review

Yuan

Guo²

2020

Preprint

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Background: Hepatocellular carcinoma with right atrial tumor thrombus is uncommon but with a dismal prognosis. Methods: By comprehensive retrieval of literature published between 2000 and 2019, 53 reports were obtained with 187 patients recruited into this study. The extracted data included patient characteristics, tumor characteristics, treatment, follow-up and outcomes. Statistical analyses applied were student t , Fisher exact and I 2 tests. Patients were devided into 6 groups according to treatment of choices: transarterial chemoembolization (TACE), surgery, radiotherapy, chemotherapy, interventional treatment and supportive care. Results: The overall survival rate of this cohort was 40.8%. The survival rate of patients receiving TACE was 33.3% and that of surgical patients was 41.9%. The survival time of patients with TACE was longer than surgical patients, but lack of a statistical significance. Patients had a follow-up of 15.7±16.6 (median 10) months. The patients receiving radiotherapy had the longest follow-up among all groups. Intra- and/or extrahepatic recurrence of hepatocellular carcinoma was the major mobidity. The mortality rates in a decremental sequence for patients receiving different treatments were supportive care >radiotherapy >surgery >TACE >interventional treatment. No difference was found in mortality between patients reported from case reports and those from non-case reports. Conclusions: Even though advanced hepatocellular carcinoma with right atrial thrombus is an aggressive malignancy, the the present study showed that patients’ prognosis was improved and survival time elongated with active treatments such as TACE and surgery. The present systematic review reveals improved outcomes with active treatments against conservative treatments.

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“…Type III describes thrombi that reach to the right atrium and require hemihepatectomy and thrombectomy with cardiopulmonary bypass [22]. There are many case reports indicating a beneficial outcome and long survival periods of up to 15 months for patients who underwent curative resection [23]. However, to be suitable for surgical treatment, particularly with cardiopulmonary bypass, patients with HCC have to be in a good general health without severe comorbidities [16].…”

Section: Discussionmentioning

confidence: 99%

Pharmacological treatment of hepatocellular carcinoma with cavoatrial tumor thrombus – case series and literature review

et al. 2019

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Hepatocellular carcinomas (HCC) that extend into the vena cava and the right atrium have a poor prognosis. Surgical approaches including partial hepatectomy and thrombectomy are the most frequently reported treatment options. However, most patients with advanced HCC are not eligible for complex surgical interventions due to reduced liver function, comorbidities, and metastases. At the same time, systemic treatment options of HCC have expanded in recent years. Here, we report 3 cases of patients with advanced HCC who developed a cavoatrial tumor thrombus (CATT) after initial surgical or interventional therapy. The patients were consequently treated with sorafenib or nivolumab. In all cases, the tumor responded to systemic treatment with disease stabilization or partial regression. Overall survival after diagnosis of CATT was 3 and 17 months for sorafenib and 7 + months for nivolumab. Compared to survival rates of alternative treatment options, systemic therapies demonstrated comparable outcomes. In summary, pharmacotherapy is an efficient and well worth option to treat patients with HCC and CATT and should be an integral part of a multimodal therapy concept.

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Hepatocellular carcinoma on cirrhosis complicated with tumoral thrombi extended to the right atrium: results in three cases treated with major hepatectomy and thrombectomy under hypothermic cardiocirculatory arrest and literature review

Cited by 22 publications

References 25 publications

Hepatocellular carcinoma with inferior vena cava and right atrial tumor thrombus: A case report

Hepatocellular carcinoma with inferior vena cava and right atrial tumor thrombus: A case report

Hepatocellular carcinoma with right atrial tumor thrombus: a systematic review

Pharmacological treatment of hepatocellular carcinoma with cavoatrial tumor thrombus – case series and literature review

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