Resectable hepatoblastoma with tumor thrombus extending into the right atrium after chemotherapy: A case report

Endo, Kazuhira; Yokoi, Akiko; Mishima, Yasuhiko; Tamaki, Akihiko; Takemoto, Junkichi; Morita, Keiichi; Iwade, Tamaki; Okata, Yuichi; Fukuzawa, Hiroaki; Bitoh, Yuko; Hasegawa, Tomomi; Yoshida, Makiko; Akasaka, Yoshinobu; Okajima, Hideaki; Oshima, Yoshihiro; Murakami, Kosaku; Üemoto, Shinji

doi:10.1016/j.epsc.2016.01.004

Cited by 3 publications

(6 citation statements)

References 12 publications

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“…Previously, some cases were associated with postoperative mortality or morbidity, such as postoperative death due to pulmonary embolism, 23 and ischemic cholangiopathy requiring subsequent LT 25 . However, recent studies reported that the postoperative course was uneventful and that patients were discharged within a month after the operation 6,9,12,26 . Although we only found 3 cases in which extracorporeal circulation was used for LDLT for patients with HB (including the present case), 24 the usefulness of a venovenous bypass at LT has been already confirmed.…”

Section: Discussionsupporting

confidence: 54%

“…Vascular reconstruction with extracorporeal circulation is a challenging surgical technique in hepatic resection or LT for HB with tumor thrombi extending into the IVC and RA. To the best of our knowledge, 16 cases of extracorporeal circulation for cases of HB with IVC thrombi or RA (including the present case) have been reported, as shown in Table 1 6,9,12,22‐26 . Hepatic resection was performed under cardiopulmonary bypass with hypothermic perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, 16 cases of extracorporeal circulation for cases of HB with IVC thrombi or RA (including the present case) have been reported, as shown in Table 1. 6,9,12,[22][23][24][25][26] Hepatic resection was performed under cardiopulmonary bypass with hypothermic perfusion. Previously, some cases were associated with postoperative mortality or morbidity, such as postoperative death due to pulmonary embolism, 23 and ischemic cholangiopathy requiring subsequent LT. 25 However, recent studies reported that the postoperative course was uneventful and that patients were discharged within a month after the operation.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 To the best of our knowledge, there are only a few reports of HB with a tumor thrombus extending into the RA in which the tumor was successfully resected using extracorporeal circulation. [8][9][10] The establishment of the surgical technique for LDLT in cases involving HB extending into the RA will contribute to improving the prognosis of these patients.…”

Section: Introductionmentioning

confidence: 99%

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The extracorporeal circulation with transdiaphragmatic approach in living‐donor liver transplantation for HB with atrial extension of tumor thrombus: A case report

Shimizu

Sakamoto

Fukuda

et al. 2020

Pediatric Transplantation

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Surgical intervention for HB with tumor thrombi extending into the IVC and the RA might requires careful planning of the surgical procedures, including vascular reconstruction and extracorporeal circulation. We herein report a successful case of LDLT for HB with atrial extension of a tumor thrombus by extracorporeal circulation with a transdiaphragmatic approach. The patient was a 5‐year‐old boy with PRETEXT IV HB with a tumor thrombus that extended into the IVC and the RA. After 4 cycles of chemotherapy and resection of bilateral lung metastases, the size of the primary HB tumor decreased. As the tumor extension from the LHV to the RA had decreased but was still present, we performed LDLT with tumor thrombectomy. The central part of the diaphragm was sagittally incised to expose the suprahepatic IVC and the RA. Venovenous bypass was achieved from the right femoral vein and IMV to the RA En bloc resection of the native liver with the tumor thrombus was then performed. HV anastomosis was made between the newly created orifice on the IVC and the graft LHV. The duration of LDLT was 10 hours and 44 minutes (extracorporeal circulation time: 78 minutes). Pediatric LT for HB with the extension of tumor thrombi into the RA under extracorporeal circulation is a feasible option and allows for the expansion of the indications for transplantation for children with unresectable liver tumors.

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Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The extracorporeal circulation with transdiaphragmatic approach in living‐donor liver transplantation for HB with atrial extension of tumor thrombus: A case report

Shimizu

Sakamoto

Fukuda

et al. 2020

Pediatric Transplantation

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“…Previously reported cases have been managed with concomitant cardiac and liver surgery [4,5]. In other cases, cardiac metastases have completely resolved with chemotherapy, thereby requiring no surgery or less complex surgeries [6,7]. We present the perioperative anesthetic management of a case of hepatoblastoma with right atrial invasion at diagnosis, with no regression in size of the tumor with chemotherapy, treated subsequently with combined cardiac and liver surgery.…”

Section: Introductionmentioning

confidence: 99%

Anesthetic Approach to a Case of Hepatoblastoma With Right Atrial Spread for Simultaneous Resection of Both

Chatterejee¹,

Subramanian²,

Panneerselvam³

2022

Cureus

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Hepatoblastoma is the most common primary liver tumor in childhood. However, cases involving age >5 years are extremely rare. Invasion of the inferior vena cava and right atrium in hepatoblastoma places the patient in a high-risk group, and due to the rarity of such presentation, the preferred surgical approach is not clear. We present the perioperative anesthetic management of hepatoblastoma in an eight-year-old child with right atrial invasion at diagnosis, with no regression in size of the tumor after chemotherapy, treated subsequently with combined cardiac and liver surgery. Due to the possibility of impingement of the tumor thrombus onto the tricuspid valve or superior vena cava, or systemic embolization from the right atrium, access for the cardiopulmonary bypass was kept ready at the start of surgery. Intraoperative evidence of fragmentation of a small part of the right atrial tumor was noted in trans-esophageal echocardiography midway during left hepatectomy. This necessitated the emergency institution of cardiopulmonary bypass and en-bloc removal of the tumor thrombus with the remaining left hepatectomy specimen. The anesthetic management was further compounded by the risk of peri-operative pulmonary embolization, coagulopathy, blood loss and hemodynamic instability, ischemia-reperfusion injury, and post-operative hepatic, renal and pulmonary complications inherent in hepatectomies. The case presented a unique set of challenges to both surgeons and anesthetists. What was most evident from the successful management of such a case was the need for a team approach, with adequate communication between teams managing the patient.

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Management of anesthesia and cardiopulmonary bypass of pediatric abdominal tumor invading inferior vena caval and right atrium: our clinical experience

et al. 2023

Preprint

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Objective Abdominal tumor with inferior vena caval (IVC) and right atrium tumor thrombus is relatively rare in children. In this paper,we summarize the management of anesthesia and cardiopulmonary bypass(CPB) during the multidisciplinary treatment(MDT). Methods We retrospectively analyzed the clinical data of children with abdominal tumor with inferior vena caval and right atrium tumor thrombus from January 2012 to December 2022,who had been performed surgeon under CPB. We summarize the management of anesthesia and CPB, intraoperative hemorrhage ,arterial blood gas, blood transfusion, postoperative outcome,follow-up and so on. Results 6 pediatric patients with IVC and right atrium tumor thrombus from abdominal tumor underwent surgical treatment with CPB. The primary malignancies were nephroblastom (n = 2), renal clear cell carcinoma(n = 1) and hepatoblastoma (n = 3). In all cases the primary tumor and tumor thrombus were completely removed. In all these patients, the mean age was 25.8 months (range 14-41months). The mean operative time was 459.8 min (range 365–580 min) and the mean anaesthesia time was 553.1 min (range 450–745 min). The mean cardiopulmonary bypass time was 150.3 min (range 91–261) .The mean cardiopulmonary bypass time was 150.3 min (range 91–261 min). The mean aortic block time was 46.1min (range 24–68 min) and the mean hypothermic circulatory arrest time was 22 min (range 3–46 min).The mean volume of red blood concentrates (RBC) transfuion was 5.1U(range 3-9.5U). There were all survival and no serious complications occurred after operation untill December 2022 for the follow-up. Conclusions Pediatric abdominal tumor with IVC and right atrium tumor thrombus is relatively rare, and the management of anesthesia and CPB for this multidisciplinary surgical treatment have not been reported.Thus, our report provides clinical experience of the management of anesthesia and CPB. Induction of anesthesia steadily and intraoperative massive hemorrhage are the major challenges during anesthetic management, as well as the management of intraoperative critical situations.

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Resectable hepatoblastoma with tumor thrombus extending into the right atrium after chemotherapy: A case report

Cited by 3 publications

References 12 publications

The extracorporeal circulation with transdiaphragmatic approach in living‐donor liver transplantation for HB with atrial extension of tumor thrombus: A case report

The extracorporeal circulation with transdiaphragmatic approach in living‐donor liver transplantation for HB with atrial extension of tumor thrombus: A case report

Anesthetic Approach to a Case of Hepatoblastoma With Right Atrial Spread for Simultaneous Resection of Both

Management of anesthesia and cardiopulmonary bypass of pediatric abdominal tumor invading inferior vena caval and right atrium: our clinical experience

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