[A case report of advanced huge hepatocellular carcinoma (H.C.C.) accompanied by tumor embolism to the inferior caval vein (Vv3) that was treated with surgical extended right lobectomy after multimodal therapy].

We performed multimodal therapy for a huge hepatocellular carcinoma with tumor embolism (Vv3), for which excision was judged impossible. After treatment, a hepatectomy to the primary lesion was finally carried out and long-term survival was achieved. A 52-years-old man with right lateroabdominal pain had a huge occupied hepatocellular carcinoma that was detected in October 2000. A tumor embolism, which invaded the inferior vena cava, was also seen. The residual liver was judged to have insufficient capacity for a right hepatic lobectomy. A percutaneous transhepatic portal embolism (PTPE) was carried out against the right portal vein to increase in the left lobe capacity. The chemo-radiotherapy (36 Gy to the right hepatic vein and systemic administration of CDDP) and transcatheter arterial chemoembolization were added to the feeding arteries of the hepatic tumor. When a decrease in the postcaval vein tumor embolism was observed, the extended right hepatic lobectomy was performed. The postoperative course was good, and the patient was discharged from the hospital on postoperative day 41. Though lung metastasis and new lesions in left lobe were seen in a recurrence, two years and ten months since the start of the systemic chemotherapy. This case suggested that even if a huge liver cancer with vascular invasion is judged impossible to excise, multimodal therapy with the aim of surgical treatment helps retain the possibility to later chose hepatectomy for the primary lesion and improve prognosis.