Abstract
A 76-year-old man was admitted to our hospital with a liver tumor. Abdominal CT showed the liver tumor was located in the Spiegel lobe with a vena cava tumor thrombus. Cavagraphy showed that the thrombus did not reach to the conflunence of the vena cava and the hepatic vein. At the time of operation, we placed a temporary IVC filter to prevent pulmonary embolism from dislodgement of the tumor thrombus, followed by a caudate lobectomy with thrombectomy. Blood pressure was maintained by clamping the IVC below the hepatic vein. THVE (Total hepatic vascular exclusion) was not necessary. The patient survived 16 months after the operation but died of intrahepatic reccurence and pulmonary metastases. The prognosis of hepatocellular carcinoma with IVC thrombus is dismal, but a possibility of long term survival may be altained by resection, if the operation can be safely performed. Administration of effective adjuvant chemotherapy and chemotherapy for intra, and extrahepatic recurrence is required to improve the long term survival.
