Resection of hepatic tumors with central venous and right atrial extension using cardiopulmonary bypass

Abstract

Background: Pediatric liver tumors occasionally present with vascular invasion. Standard anatomic resections usually result in complete resection when tumor is intra-hepatic; however, direct tumor extension into the inferior vena cava (IVC) and right atrium (RA) requires additional considerations. Here we present our surgical approach to resection of primary liver tumors directly extending into the IVC and RA. Methods: A retrospective analysis of patients undergoing hepatic resection of primary liver tumors with direct extension into the IVC and RA from 1/2013-4/2015 was performed. Results: Three patients were identified with tumors arising from the left hepatic lobe, extending into the suprahepatic IVC and RA. Two underwent in-situ parenchymal division, followed by cardiopulmonary bypass (CPB) for en-bloc resection of the intra-atrial tumor. The third had a congested right lobe due to venous obstruction by tumor, thereby requiring total hepatectomy, en-bloc intra-caval tumor excision, ex-situ left hemihepatectomy, and auto-transplantation of the right lobe. All patients required partial IVC or RA resection and reconstruction. Postoperatively, one patient died from metastatic disease at 5 months and two patients were alive after 50 months and 33 months. Conclusion: Cardiopulmonary bypass provides a safe, controlled approach for en-bloc resection of hepatic tumors extending into the IVC and RA. This minimizes the risk of tumor fracture or spillage, allowing for complete gross resection.