[A case of diffuse hepatocellular carcinoma(Vp4) treated by right hepatic trisegmentectomy and multidisciplinary...

A 59-year-old woman was admitted to our hospital for treatment of a right humerus fracture. The patient was diagnosed with hepatocellular carcinoma during work-up for hepatic dysfunction. A diffusely spreading tumor was observed from the right lobe to the medial segment of the liver, and a portal vein tumor thrombus filled the right branch of the portal vein and extended into the main trunk, accompanied by cavernous transformation (Vp4). A multidisciplinary treatment regimen including surgical intervention was planned because the patient desired aggressive treatment. Surgical intervention included a right hepatic trisegmentectomy and excision of the portal vein tumor thrombus. The patient experienced an uneventful postoperative course with no signs of hepatic failure and received transcatheter arterial chemoembolization for residual tumor in the hepatic S1 and S2 regions on post-operative day 15. Beginning at 2 months after the operation, the patient was given 3 courses of intraarterial 5-fluorouracil combined with subcutaneous interferon-α therapy. She tested negative for tumor markers at 3 months post-operatively and was noted to have no viable tumors on computed tomography scans at 5 months post-operatively. However, there was a rapid recurrence with deterioration of her general condition at 8 months after the operation, and she died of recurrence the following month. Hepatocellular carcinoma complicated by portal vein tumor thrombus has an unfavorable prognosis, but it was considered feasible to improve this patient's outcome by giving priority to active surgical resection of the tumors including the tumor thrombus, and by undertaking multidisciplinary therapeutic measures.