A Case of Hepatocellular Carcinoma with Inferior Vena Cava Tumor Thrombosis Successfully Resected after Control of Ascites by Tolvaptan

Abstract

The prognosis of hepatocellular carcinoma patients with tumor thrombosis of the inferior vena cava (Vv3 HCC) has been reported to be poor. However, because the condition can cause sudden death, a so-called “oncological emergency”, resection is sometimes required as soon as possible. A Vv3 HCC case with ascites that could be resected after control of ascites with tolvaptan and hepatic arterial infusion chemotherapy (HAIC) is reported.

A 55-year-old man with alcoholic hepatitis was diagnosed with Vv3 HCC by tumor marker (AFP, PIVKA-II) elevations and computed tomography (CT). He had been treated by trans-catheter arterial chemoembolization (TACE) with no therapeutic effect. He was referred to our hospital for surgical therapy. Hepatectomy was planned, but preoperative CT indicated ascites. The operation was postponed, and HAIC and control of ascites by tolvaptan were started. The ascites disappeared after one month, and right hepatectomy and tumor thrombectomy were performed.

After 6 months, metastases at the remnant liver and lung were found, but with HAIC and radiotherapy for recurrence, he has survived for 2 years and 6 months.