Hepatocellular carcinoma (HCC), which is one of the most common malignancies, accounts for 6% of all malignant lesions in the world [1] . The outlook for HCC is dismal if it is left untreated and the treatment for patients with HCC evolved into a complex task that incorporates information regarding the extent of metastasis, severity of the underlying hepatic dysfunction, general medical condition of the patient, and available resources [2, 3] . The mainly surgical therapies include hepatic resection (HR) and liver transplantation (LT). Although HR is a well accepted therapy for HCC, local excision and major hepatectomy have failed to produce a favorable survival figure over the last decade [4] . Orthotopic liver transplantation (OLT) is a rational therapeutic option for patients with HCC, because it may eliminate both the tumor and the underlying liver disease. In this study, we reported a patient with HCC and portal vein tumor thrombus (PVTT) undergoing combined pancreatoduodenectomy with OLT and surviving for 23 months in our center.
Case reportA 44-year-old man with advanced liver cirrhosis and hepatitis B virus (HBV) for more than 20 years complaining progressive obstructive jaundice and upper abdominal pain for 20 days was admitted to a local hospital on May 2006. Abdominal ultrasonography (USG) and computer tomography (CT) image showed a multifocal HCC located in the hepatic portal and splenectasis. For the patient had severe liver cirrhosis and unresectable HCC. OLT was considered for the patient after clinical evaluation.The patient was therefore transferred to our department for further assessment and liver transplantation on May 23th, 2006. On the admission to our hospital, suspected portal vein tumor thrombus was found by Doppler USG but no other malignant lesion of vasa sanguinea was found. The preoperative evaluation of the tumor markers demonstrated that alpha-fetoprotein (AFP) > 20 µg/L. The patient were screened, by imaging the abdomen, chest and head with CT or magnetic resonance imaging (MRI) and by bone scintigraphy to detect extrahepatic spread of disease and no malignant lesion was found.On June 7th, 2006, the patient underwent an exploratory laparotomy beginning with a complete exploration of the abdomen to exclude distant spreading and seeding. At laparotomy, several tumors from 3-5 cm in diameter were found in the hepatic portal. Segment IV of the liver and portal vein had been invaded. Tumor thrombus in the portal vein trunk was proved. In the same time, swollen lymph nodes in the hepatoduodenal ligament and head of the pancreas were detected. However, no other Abstract Hepatocellular cancer (HCC) is the most common primary malignant hepatic tumor that accounts for over 80% of primary liver tumors. The outlook for HCC is dismal if it is left untreated and the treatment for patients with HCC evolved into a complex task. The treatments for HCC are mainly surgical therapies including hepatic resection (HR) and liver transplantation. Although HR is a well accepted therapy for HCC, it is no...
