A 90-year-old man was admitted to our hospital for treatment of a huge hepatocellular carcinoma (HCC). He had undergone aortic valve replacement 2 years earlier at another hospital. Abdominal contrast-enhanced computed tomography and Gd-EOB-DTPA magnetic resonance imaging revealed a huge hypervascular tumor with a diameter of 12 cm in liver segment 4. Laboratory data were as follows : aspartate aminotransferase, 37 IU/l ; alanine aminotransferase, 21 IU/l ; hepatitis B surface antigen-negative ; hepatitis B core antibody-negative ; hepatitis C virus antibody-negative ; α-fetoprotein, 5.7 ng/ml ; protein induced by vitamin K absence or antagonist-II (PIVKA-II), 220,000 mAU/ml ; and indocyanine green test R15, 16%. With a diagnosis of non-B, non-C HCC, transcatheter arterial chemo-embolization (TACE) was performed to reduce tumor size. However, tumor size and PIVKA-II level did not decrease. To prevent rupture of the huge HCC, extended lateral segmentectomy of the liver with middle hepatic vein tumor embolectomy was performed after immunonutrition and respiratory exercise. The histological diagnosis was moderately differentiated HCC (pT3, Stage III). Postoperative course was uneventful and he was discharged on the 20th postoperative day. Hepatic resection can be performed even in extremely elderly patients in good general physical condition with appropriate perioperative management.
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