Multimodal approach to portal hypertension and gastric varices before hepatic resection for hepatocellular carcinoma: a case report

Abstract

Background: Liver cirrhosis occurs in approximately 80-90% of patients with hepatocellular carcinoma (HCC), and hepatic resection may be dangerous because of well-documented liver cirrhosis, which may be accompanied by portal hypertension (PH). Here we report a patient with advanced HCC with gastric varices and PH who experienced a good clinical course after undergoing balloon-occluded retrograde transvenous obliteration (BRTO), percutaneous transhepatic portal vein embolization (PTPE), hand-assisted laparoscopic (HALS) splenectomy, and right lobectomy of the liver. Case presentation: A 72-year-old man had two HCCs with gastric varices. CT revealed one tumor (4.5 cm) located in segment 7, involving the right hepatic vein, adjacent to the middle hepatic vein. Another tumor (2.7 cm) was located in segment 6. He first underwent BRTO for gastric varices and PTPE for planned right lobectomy of the liver. To reduce PH, HALS splenectomy was performed, and uncomplicated right lobectomy of the liver was performed 10 weeks after the first visit. He has remained free of recurrence for at least 1 year. Conclusions: Our patient underwent uncomplicated BRTO, PTPE, HALS splenectomy, and right lobectomy of the liver for advanced HCC with PH. Controlling portal pressure is important when hepatic resection is required to treat HCC with PH.

Safe perioperative management of major hepatectomy in a patient with portal hypertension after elimination of hepatitis C: a case report

“…Hepatic resection for patients with PH is not indicated in Europe and the United States, but the safety of partial resection has been reported in Japan [ 3 ]. In addition, appropriate management of PH, such as endoscopic treatment of esophageal and gastric varices, Hassab’s procedure, and preoperative treatment for splenomegaly by splenectomy, or PSE, allows safe liver resection [ 11 – 13 ]. Preoperative endoscopic treatments for varices and Hassab’s procedure could prevent the postoperative rupture of uncontrolled varices.…”