Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report
Abstract Background Liver cirrhosis occurs in approximately 80–90% of patients with hepatocellular carcinoma (HCC), and hepatic resection may be dangerous because of well-documented liver cirrhosis, which may be accompanied by portal hypertension (PH). Here we report a patient with advanced HCC with...
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Japan Surgical Society
2020-07-01
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| Series: | Surgical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40792-020-00952-4 |
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| author | Norifumi Harimoto Kenichiro Araki Ryo Muranushi Kouki Hoshino Kei Hagiwara Norihiro Ishii Mariko Tsukagoshi Takamichi Igarashi Akira Watanabe Norio Kubo Kei Shibuya Masaya Miyazaki Hirofumi Kawanaka Ken Shirabe |
| author_facet | Norifumi Harimoto Kenichiro Araki Ryo Muranushi Kouki Hoshino Kei Hagiwara Norihiro Ishii Mariko Tsukagoshi Takamichi Igarashi Akira Watanabe Norio Kubo Kei Shibuya Masaya Miyazaki Hirofumi Kawanaka Ken Shirabe |
| author_sort | Norifumi Harimoto |
| collection | DOAJ |
| description | Abstract Background Liver cirrhosis occurs in approximately 80–90% of patients with hepatocellular carcinoma (HCC), and hepatic resection may be dangerous because of well-documented liver cirrhosis, which may be accompanied by portal hypertension (PH). Here we report a patient with advanced HCC with gastric varices and PH who experienced a good clinical course after undergoing balloon-occluded retrograde transvenous obliteration (BRTO), percutaneous transhepatic portal vein embolization (PTPE), hand-assisted laparoscopic (HALS) splenectomy, and right lobectomy of the liver. Case presentation A 72-year-old man had two HCCs with gastric varices. CT revealed one tumor (4.5 cm) located in segment 7, involving the right hepatic vein, adjacent to the middle hepatic vein. Another tumor (2.7 cm) was located in segment 6. He first underwent BRTO for gastric varices and PTPE for planned right lobectomy of the liver. To reduce PH, HALS splenectomy was performed, and uncomplicated right lobectomy of the liver was performed 10 weeks after the first visit. He has remained free of recurrence for at least 1 year. Conclusions Our patient underwent uncomplicated BRTO, PTPE, HALS splenectomy, and right lobectomy of the liver for advanced HCC with PH. Controlling portal pressure is important when hepatic resection is required to treat HCC with PH. |
| format | Article |
| id | doaj-art-2901dda243a04743b0cfcbf4dcfaa1e5 |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2020-07-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-2901dda243a04743b0cfcbf4dcfaa1e52025-08-20T02:41:58ZengJapan Surgical SocietySurgical Case Reports2198-77932020-07-01611810.1186/s40792-020-00952-4Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case reportNorifumi Harimoto0Kenichiro Araki1Ryo Muranushi2Kouki Hoshino3Kei Hagiwara4Norihiro Ishii5Mariko Tsukagoshi6Takamichi Igarashi7Akira Watanabe8Norio Kubo9Kei Shibuya10Masaya Miyazaki11Hirofumi Kawanaka12Ken Shirabe13Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma UniversityDepartment of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma UniversityDepartment of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma UniversityDepartment of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma UniversityDepartment of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma UniversityDepartment of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma UniversityDepartment of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma UniversityDepartment of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma UniversityDepartment of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma UniversityDepartment of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma UniversityDepartment of Radiation Oncology, Graduate School of Medicine, Gunma UniversityDepartment of Applied Medical Imaging, Graduate School of Medicine, Gunma UniversityClinical Research Institute and Department of Surgery, National Hospital Organization, Beppu Medical CenterDepartment of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma UniversityAbstract Background Liver cirrhosis occurs in approximately 80–90% of patients with hepatocellular carcinoma (HCC), and hepatic resection may be dangerous because of well-documented liver cirrhosis, which may be accompanied by portal hypertension (PH). Here we report a patient with advanced HCC with gastric varices and PH who experienced a good clinical course after undergoing balloon-occluded retrograde transvenous obliteration (BRTO), percutaneous transhepatic portal vein embolization (PTPE), hand-assisted laparoscopic (HALS) splenectomy, and right lobectomy of the liver. Case presentation A 72-year-old man had two HCCs with gastric varices. CT revealed one tumor (4.5 cm) located in segment 7, involving the right hepatic vein, adjacent to the middle hepatic vein. Another tumor (2.7 cm) was located in segment 6. He first underwent BRTO for gastric varices and PTPE for planned right lobectomy of the liver. To reduce PH, HALS splenectomy was performed, and uncomplicated right lobectomy of the liver was performed 10 weeks after the first visit. He has remained free of recurrence for at least 1 year. Conclusions Our patient underwent uncomplicated BRTO, PTPE, HALS splenectomy, and right lobectomy of the liver for advanced HCC with PH. Controlling portal pressure is important when hepatic resection is required to treat HCC with PH.http://link.springer.com/article/10.1186/s40792-020-00952-4Hepatocellular carcinomaPortal hypertensionPortal vein embolizationBalloon-occluded retrograde transvenous obliterationHepatic resection |
| spellingShingle | Norifumi Harimoto Kenichiro Araki Ryo Muranushi Kouki Hoshino Kei Hagiwara Norihiro Ishii Mariko Tsukagoshi Takamichi Igarashi Akira Watanabe Norio Kubo Kei Shibuya Masaya Miyazaki Hirofumi Kawanaka Ken Shirabe Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report Surgical Case Reports Hepatocellular carcinoma Portal hypertension Portal vein embolization Balloon-occluded retrograde transvenous obliteration Hepatic resection |
| title | Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report |
| title_full | Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report |
| title_fullStr | Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report |
| title_full_unstemmed | Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report |
| title_short | Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report |
| title_sort | multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma a case report |
| topic | Hepatocellular carcinoma Portal hypertension Portal vein embolization Balloon-occluded retrograde transvenous obliteration Hepatic resection |
| url | http://link.springer.com/article/10.1186/s40792-020-00952-4 |
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