Table 1 Course of the three patients with tumor thrombi in the IVC, RA, and phrenic vein
Case no. | 1 | 2 | 3 | |
|---|---|---|---|---|
Age, years | 69 | 40 | 75 | |
Sex | Male | Female | Female | |
Preoperative information | Etiology | Alcoholic | Unknown | HCV |
Past treatment | 1. 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, B | 5, A | 6, A | |
Tumor markers before surgery | AFP 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 location | IVC, RA, diaphragm | S7, IVC, RA, diaphragm | S7, IVC, RA, diaphragm | |
Operative findings | Surgical procedure | RA thrombectomy Diaphragm resection | RA thrombectomy Diaphragm resection Posterior sectionectomy | RA thrombectomy Diaphragm resection |
Hepatectomy | − | + | − | |
Operation time | 9 h 2 min | 10 h 0 min | 8 h 15 min | |
THVE time, min | 26 | 21 | 25 | |
V-V bypass | − | + | + | |
Bleeding, g | 2705 | 1080 | 4230 | |
Pathological findings | Differentiation | Poor | Moderate | Poor |
Surgical margin | +, diaphragm | +, diaphragm | +, diaphragm | |
Postoperative course | Complication | Pleural effusion | Pleural effusion | Respiratory failure Pleural effusion |
Postoperative stay, days | 42 | 14 | 43 | |
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 surgery | Sorafenib | Sorafenib | Sorafenib | |
Recurrence | Parasternal site | Lung, bone | Remnant liver (S7) | |
PFS, months | 20.2 | 3.8 | 9.5 | |
Death | Liver cirrhosis | Acute heart failure | HCC | |
Postoperative survival, months | 98.0 | 38.9 | 30.9 | |