A Case of Conversion Hepatectomy for Hepatocellular Carcinoma with Vp4 Portal Vein Tumor Thrombosis after Lenvatinib Therapy

Abstract

A 70-year-old man was referred to our hospital with a diagnosis of ruptured hepatocellular carcinoma in segment 4 of the liver and transcatheter arterial embolization (TAE) was subsequently carried out on an emergency basis. At that time a contrast-enhanced CT scan revealed a portal vein thrombus (Vp4) from the left branch to the main trunk. Systemic chemotherapy was selected, and we started treatment with lenvatinib (12mg/day) in December 2019. The tumor responded well to the 6-week treatment, CT showed shrinkage of both the tumor and portal vein thrombus, and conversion surgery was decided. Laparoscopic left hepatectomy was performed in February 2020. Intraoperatively, the left portal vein was divided after the absence of tumor thrombus was confirmed with intraoperative ultrasonography. The postoperative course was uneventful and the patient has been alive for 2 years postoperatively without recurrence.