Detailed Abstract
[Poster - Liver Disease/Surgery]
[P026] Successful resection for huge combined hepatocellular-cholangiocarcinoma after portal vein embolization - a case report
PO-CHIH YANG1, HSIN-CHIEH HUANG2, KAI-WEN HUANG3
1Department of Surgery, Fu Jen Catholic University Hospital, Taiwan
2Department of Medical Imaging, National Taiwan University Hospital, Taiwan
3Center of Mini-Invasive Interventional Oncology, National Taiwan University Hospital, Taiwan, Taiwan
Introduction : Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a rare primary hepatic cancer with poor prognosis. Aggressive surgical planning with complete resection of cHCC-CC plays an important role in treatment. We presented one case of successful resection of huge cHCC-CC after portal vein embolization (PVE).
Methods : This is a 46-year-old man with alcoholic liver cirrhosis. CT scan showed one 10cm infiltrative tumor in right liver with right anterior portal venous tumor thrombosis enhanced in arterial phase and washed out in portal venous phase. Regional enlarged lymph nodes is also noted. Under the preoperative diagnosis of HCC, right hepatectomy is planned. CT volumetry showed future liver remnant(FLR) is 480ml, 38.5% of standard liver volume. The ideal percentage of FLR in cirrhotic liver is more than 40% in our institution. Because of tumor thrombosis with total occlusion in right anterior portal pedicle, we performed PVE to right posterior portal vein for inadequate FLR. Two weeks after PVE, left liver enlarged from 480ml(38.5%) to 620ml(49.7%). There was no complication during PVE.
Results : Right hepatectomy and regional lymph node dissection were performed two weeks after PVE. The post-operative course was smooth without any evidence of hepatic insufficiency. Pathology reported combined hepatocellular-cholangiocarcinoma but no malignant lymph nodes. There is no evidence of recurrence in follow-up CT scan 17 months after the operation until now.
Conclusions : Aggressive surgical planning with PVE is effective for patient with cHCC-CC without adequate FLR even in cirrhotic liver. Complete resection may provide longer overall survival in this disease with dismal prognosis.
Methods : This is a 46-year-old man with alcoholic liver cirrhosis. CT scan showed one 10cm infiltrative tumor in right liver with right anterior portal venous tumor thrombosis enhanced in arterial phase and washed out in portal venous phase. Regional enlarged lymph nodes is also noted. Under the preoperative diagnosis of HCC, right hepatectomy is planned. CT volumetry showed future liver remnant(FLR) is 480ml, 38.5% of standard liver volume. The ideal percentage of FLR in cirrhotic liver is more than 40% in our institution. Because of tumor thrombosis with total occlusion in right anterior portal pedicle, we performed PVE to right posterior portal vein for inadequate FLR. Two weeks after PVE, left liver enlarged from 480ml(38.5%) to 620ml(49.7%). There was no complication during PVE.
Results : Right hepatectomy and regional lymph node dissection were performed two weeks after PVE. The post-operative course was smooth without any evidence of hepatic insufficiency. Pathology reported combined hepatocellular-cholangiocarcinoma but no malignant lymph nodes. There is no evidence of recurrence in follow-up CT scan 17 months after the operation until now.
Conclusions : Aggressive surgical planning with PVE is effective for patient with cHCC-CC without adequate FLR even in cirrhotic liver. Complete resection may provide longer overall survival in this disease with dismal prognosis.
SESSION
Poster
Poster / Exhibition Hall and Lobby(2F) 1/1/1970 9:00 AM - 9:00 AM