One Stage Radical Operation for Budd-Chiari Syndrome Combined with Hepatocellular Carcinoma

Abstract

Between November 1979 and August 2001, we performed 44 radical operations which consisted of reconstruction of the occluded inferior vena cava and reopening of the hepatic veins under femoro-femoral partial cardiopulmonary bypass for Budd-Chiari syndrome. The cumulative survival rate of these 44 patients was 80% at 10 year and 70% at 20 year respectively. Nine of the patients had combined hepatocellular carcinoma. Six of the hepatocellular carcinomas occured 3 to 9 year after the radical operation and transcatheter arterial chemoembolization or liver resection was carried out. The remaining 3 hepatocellular carcinoma cases were simultaneously diagnosed with the Budd-Chiari syndrome. The 3 patients were 38, 73 and 76 years old, one female and two male. Transcatheter arterial chemoembolization was done 1 month to 2 months preoperatively after which the one stage operation which consisted of radical operation and liver resection was carried out. The postoperative course of these three patients was good despite liver cirrhosis in all with a 32.8% of ICG15 min value in one and high age in one of 76 years old. Three patients was doing well without any recurrence from 1 year to 13 year 1 month after operation. We think that this one stage operation is safe and useful for prolonging survival and the indication can be extended to the more high risk patient.