Concomitant Hepatectomy and Atrial Thrombectomy under Cardiopulmonary Bypass versus Staged Hepatectomy in the Treatment for Hepatocellular Carcinoma with Large Right Atrial Tumor Thrombi

Wen Shan Chao, Ching Hui Shen, Shao Ciao Luo, Feng Hsu Wu, Hao Ji Wei, Chu Leng Yu, Cheng Chung Wu, Yun Yen, Fang Ku P’eng

Research output: Contribution to journalArticlepeer-review

Abstract

(1) Background: Hepatocellular carcinoma (HCC) with a large right atrium tumor throm-bus (RATT) is a rare and critical presentation. Emergency hepatectomy and thrombectomy under cardiopulmonary bypass (CPB) is life-saving and potentially curative. The aim of this study is to propose an appropriate approach for this condition. (2) Methods: In period A (1998 to 2010, n = 7), hepatectomy and thrombectomy were concomitantly performed, and staged hepatectomy was performed in period B (2011 to 2018, n = 17). (3) Results: The median overall survival time (MOST) in the published studies was 14 months. Moreover, the blood loss, blood transfusion rate, length of ICU stays, and hospital costs were significantly reduced in period B. The MOSTs of patients in period A (n = 6) and period B (n = 17) were 14 vs. 18 months (p = 0.099). The median disease-free survival times (MDFTs) in period A (n = 6) and period B (n = 15) were 8 vs. 14 months (p = 0.073), while the MOSTs in period A and period B were 14 vs. 24 months (p = 0.040). (4) Conclusions: Emergency thrombectomy under CPB and staged hepatectomy 4–6 weeks later may be an appropriate approach for HCC with large RATT. However, the optimal waiting interval requires further investigation.

Original languageEnglish
Article number2140
JournalJournal of Clinical Medicine
Volume11
Issue number8
DOIs
Publication statusPublished - Apr 2022

Keywords

  • atrial thrombectomy
  • cardiopulmonary bypass
  • hepatectomy
  • hepatocellular carcinoma
  • large right atrial tumor thrombi

ASJC Scopus subject areas

  • Medicine(all)

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