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Table 1 Course of the three patients with tumor thrombi in the IVC, RA, and phrenic vein

From: Resection of recurrent hepatocellular carcinoma with thrombi in the inferior vena cava, right atrium, and phrenic vein: a report of three cases

Case no.123
Age, years694075
SexMaleFemaleFemale
Preoperative informationEtiologyAlcoholicUnknownHCV
Past treatment1. TACE (left lobe, S8)
2. Left hepatectomy
3. RFA (S8)
1. Lateral sectionectomy
2. TACE (S7, S8)
1. TACE
2. PEIT, RFA
3. TACE, RFA (S7, 8)
Child-Pugh (score, grade)7, B5, A6, A
Tumor markers before surgeryAFP 912 ng/mL
PIVKA-II 294 U/mL
AFP 15 ng/mL
PIVKA-II 25681 U/mL
AFP 9521 ng/mL
PIVKA-II 4476 U/mL
Tumor locationIVC, RA, diaphragmS7, IVC, RA, diaphragmS7, IVC, RA, diaphragm
Operative findingsSurgical procedureRA thrombectomy
Diaphragm resection
RA thrombectomy
Diaphragm resection
Posterior sectionectomy
RA thrombectomy
Diaphragm resection
Hepatectomy+
Operation time9 h 2 min10 h 0 min8 h 15 min
THVE time, min262125
V-V bypass++
Bleeding, g270510804230
Pathological findingsDifferentiationPoorModeratePoor
Surgical margin+, diaphragm+, diaphragm+, diaphragm
Postoperative courseComplicationPleural effusionPleural effusionRespiratory failure
Pleural effusion
Postoperative stay, days421443
Tumor marker (3POM)AFP 89 ng/mL
PIVKA-II 79 U/mL
AFP 16 ng/mL
PIVKA-II 633 U/mL
AFP 573 ng/mL
PIVKA-II 3021 U/mL
CTx after surgerySorafenibSorafenibSorafenib
RecurrenceParasternal siteLung, boneRemnant liver (S7)
PFS, months20.23.89.5
DeathLiver cirrhosisAcute heart failureHCC
Postoperative survival, months98.038.930.9
  1. Abbreviations: IVC inferior vena cava, RA right atrium, HCV hepatitis C virus, TACE trans-catheter arterial chemoembolization, PEIT percutaneous ethanol injection therapy, RFA radiofrequency ablation, AFP alpha-fetoprotein, PIVKA-II protein-induced by vitamin K absence-II, THVE total hepatic vascular exclusion, POM post-operative month, CTx chemotherapy, PFS progression free survival, HCC hepatocellular carcinoma