Background Tumors invading the inferior vena cava (IVC) and hepatic veins pose a challenge
for surgeons. Hannoun et al.1 were able to show that the resection of these tumors
can be done under hypothermia in the Ante-Situm position. Additionally, not only the
localization of the tumor but the remaining volume of the remnant liver (FLR) needs
to be considered. Schnitzbauer et al.2 were able to induce massive liver hypertrophy
in a short period, combining an in-situ split with a portal vein ligation (ALPPS).
As this controversial technique has evolved, a safe ALPPS can be performed nowadays.3
To our knowledge, this is the first case that combines a laparoscopic partial ALPPS
with an extended resection requiring cardiopulmonary bypass (CPB). Methods A 58-year-old
female presented with a known chronic hepatitis C suffered from a pulmonary embolism,
caused by a large, central hepatocellular carcinoma (HCC) with invasion of the suprahepatic
IVC and continuous growth into the right atrium (RA). Due to the small FLR, we performed
a laparoscopic hybrid-partial-ALPPS with an embolization of the right portal vein.
We were able to remove the mass with an Ante-Situm position and resection of the RA
under CPB. Results The postoperative course was complicated by posthepatic liver failure
and bleeding. However, after 28 days the patient was discharged in a good medical
condition. Conclusions Although tumors invading the suprahepatic IVC and RA pose a
surgical challenge, patients can be treated adequately with multidisciplinary management.
Advanced HCCs have high recurrence rates; however, a R0 resection might improve overall
survival. Wakayma et al. showed in their retrospective study with 13 patients a median
survival of 30.8 months when a complete resection was performed.4 Our patient had
a disease-free survival of 11 months and is still alive after 24 months. Taking the
complexity of the operation and the oncological prospect with a probable recurrence
into account, indication for surgery needs to be considered on an individual basis.
