Left hemi-hepatectomy combined with portal and cavo-atrial thrombectomy for liver tumor under hypothermic cardio-circulatory arrest.

Vascular invasion of portal trunk and supra-hepatic veins extended to the atrium is a major complication of liver tumours. This may produce bleeding from oesophageal varices and/or liver failure, occlusion of the tricuspid valve and/or pulmonary embolism with sudden cardiac arrest. Therapeutics options at this stage of the disease are few and debatable. The presence of macroscopic vascular infiltration contraindicated liver transplantation and, liver resection with thrombectomy, was the only therapeutic option in this setting . A 45 years old male with a chronic hepatitis HCV- related was referred to our department for a mass in the left hemi-liver (segments I to IV), occasionally found at US that a contrast enhanced CT scan showed to invade left portal branch and left-middle hepatic veins with tumour thrombi extending toward the right portal branch and the right atrium respectively. We reported a successful left liver hepatectomy combined with portal and cavo-atrial thrombectomy using hypothermic cardio-circulatory arrest. This technique has been used few times for liver tumours because of the concern for post-operative liver failure and to our knowledge this is the second case reported in literature for primary liver cancer. Post-operative outcome was excellent with a good liver function. We conclude that this technique should be considered for atrial thrombi removal in patient affected by primary liver tumours in presence of a healthy liver or a well compensated liver cirrhosis in order to prolong the patient’s life span.