Obara Shinsaku, Nomi Takeo, Yamato Ichirou, Hokuto Daisuke, Yasuda Satoshi, Kawaguchi Chihiro, Yoshikawa Takahiro, Sho Masayuki, Yamada Takatsugu, Akahori Takahiro, Kinoshita Shoichi, Nagai Minako, Kanehiro Hiromichi, Nakajima Yoshiyuki
Dept. of Surgery, Nara Medical University.
Gan To Kagaku Ryoho. 2016 Nov;43(12):1779-1781.
The prognosis of hepatocellular carcinoma(HCC)with main portal vein(MPV)and/or the inferior vena cava(IVC)tumor thrombi is dismal. The management of HCC with severe tumor thrombus is complicated. In this study, we report a case of HCC with tumor thrombi in the MPV and IVC that was successfullytreated via liver resection and perioperative hepatic arterial infusion chemotherapy(HAI). A 68-year-old man was referred to our institution to treat huge HCC lesion in the right lobe of the liver. Abdominal computed tomography(CT)revealed a tumor(12 cm in diameter)in the right hepatic lobe and tumor thrombi in the MPV and IVC. The patient was initiallytreated with HAI(cisplatin 100mg/body). After 3 courses of HAI, the tumor was dramaticallyreduced in size, and the thrombus in the IVC had disappeared; however, the thrombus in the MPV remained. Therefore, we performed right hepatectomy, wedge resection of the IVC, combined resection of the MPV, and portal vein reconstruction. The histopathological findings of the resected specimen revealed that viable cancer cells were observed onlyin an 8×8mm lesion. Subsequently, HAI was performed as adjuvant therapy for 3 courses. The patient died of other causes 2 years 3 months after surgery. There was no sign of recurrence at the time of death. This case suggested that perioperative HAI and liver resection mayrepresent an effective treatment strategyfor HCC with severe tumor thrombus.
伴有门静脉主干（MPV）和/或下腔静脉（IVC）癌栓的肝细胞癌（HCC）预后不佳。伴有严重癌栓的HCC治疗复杂。在本研究中，我们报告了1例伴有MPV和IVC癌栓的HCC患者，经肝切除及围手术期肝动脉灌注化疗（HAI）成功治疗。一名68岁男性因右肝叶巨大HCC病灶转诊至我院。腹部计算机断层扫描（CT）显示右肝叶有一肿瘤（直径12cm），MPV和IVC有癌栓。患者最初接受HAI治疗（顺铂100mg/体）。3个疗程的HAI治疗后，肿瘤体积显著缩小，IVC内的血栓消失；然而，MPV内的血栓仍然存在。因此，我们进行了右肝切除术、IVC楔形切除术、MPV联合切除术及门静脉重建术。切除标本的组织病理学检查结果显示，仅在一个8×8mm的病灶中观察到存活癌细胞。随后，进行了3个疗程的HAI辅助治疗。患者术后2年3个月死于其他原因。死亡时无复发迹象。该病例表明，围手术期HAI和肝切除可能是伴有严重癌栓的HCC的一种有效治疗策略。
