Simultaneous radical surgical treatment for membranous obstruction of the inferior vena cava and the coincident hepatocellular carcinoma--the first successful case.

To our knowledge, this is the first report of a patient for whom a successful radical treatment for both membranous obstruction of the inferior vena cava (MOVC) and coincident hepatocellular carcinoma (HCC) were simultaneously carried out. A 36 year old Japanese man with Budd-Chiari syndrome due to MOVC was found to have HCC in the right hepatic lobe during a shunt operation between the inferior vena cava (IVC) and the right atrium (RA), using a vascular prosthetic graft. He was referred to us from another institute for further operative procedures. Both the mediastinum and the abdomen were entered through a long midline incision with longitudinal splitting of the sternum. The graft that had been occluded by thrombus was removed. Transcardiac membranotomy was achieved by manual manipulation and then by Tubb's dilator. The hepatic tumor with an abundant surgical margin of the liver was resected. The tumor of 2.5 X 2.5 X 2.0 cm was a well differentiated clear cell type HCC associated with congestive liver cirrhosis. Postoperative contrast and pressure studies through IVC showed satisfactory results. Serum alfa-fetoprotein levels decreased from 503 to 12 ng/ml. The patient is well at least for 44 months after the surgery without any recurrence at the time of completion of this writing.