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Published on: March 10, 2023
Urgent Resection of Hepatocellular Carcinoma With Intracardiac Extension Under Moderate Hypothermic Circulatory
Masaaki Kobayashi1, Satoshi Kuroyanagi1, Onichi Furuya1
1Department of Cardiovascular Surgery, Kishiwada Tokushukai Hospital, Osaka 596-0042, Japan.
Insights
Urgent cardiac surgery can effectively manage intracardiac hepatocellular carcinoma (HCC) extension via the inferior vena cava (IVC). This approach bridges patients to further multidisciplinary treatments, preventing fatal cardiac complications.
Area of Science:
- Oncology
- Cardiology
- Surgical Oncology
Background:
- Intracardiac extension of hepatocellular carcinoma (HCC) through the inferior vena cava (IVC) is rare but carries a high risk of fatal cardiac complications.
- Tumor burden in the heart and IVC can lead to hemodynamic instability and arrhythmias.
Purpose of the Study:
- To report a case of urgent cardiac surgery for intracardiac HCC extension.
- To highlight the role of surgery as a bridge to multidisciplinary treatment in selected HCC patients.
Main Methods:
- A 64-year-old male with a history of HCC underwent urgent tumor resection via moderate hypothermic circulatory arrest.
- Post-operative management included transcatheter arterial chemoembolization and systemic immunotherapy (durvalumab plus tremelimumab).
Main Results:
- Successful resection of a large right atrial mass continuous with the IVC.
- At 1-year follow-up, no intracardiac recurrence was noted, and pulmonary metastases regressed.
- The patient remained clinically stable, demonstrating the efficacy of the combined approach.
Conclusions:
- Urgent cardiac surgery is a viable strategy for managing intracardiac HCC extension.
- This surgical intervention can serve as a crucial bridge to optimize patients for subsequent multimodal therapies.
- Multidisciplinary care is essential for improving outcomes in complex HCC cases with cardiac involvement.
Abstract:
Intracardiac extension of hepatocellular carcinoma (HCC) via the inferior vena cava (IVC) is uncommon and may result in fatal cardiac complications. We report a case of urgent cardiac surgery performed to prevent imminent cardiac deterioration and facilitate subsequent multidisciplinary treatment. A 64-year-old man with a history of right hepatectomy for stage III HCC and radiofrequency ablation for recurrent disease was admitted following a traffic accident. Echocardiography revealed a 4.6 × 3.6 cm right atrial mass continuous with the IVC. Although the patient had no overt cardiac symptoms, frequent episodes of non-sustained ventricular tachycardia and bilateral lower extremity oedema raised concern regarding impending cardiac complications. Urgent tumour resection was performed under moderate hypothermic circulatory arrest (lowest rectal temperature, 32 °C). Following cardiac and orthopaedic surgery, the patient underwent transcatheter arterial chemoembolization and systemic therapy with durvalumab plus tremelimumab. At a 1-year follow-up, no intracardiac recurrence was observed, pulmonary metastatic lesions had regressed, and the patient remained clinically stable. Urgent cardiac surgery may serve as a bridge to multidisciplinary treatment in selected patients with HCC and intracardiac extension.
