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Background: Hepatocellular carcinoma (HCC) associated with major vasculature tumor extension is considered an advanced stage of disease to which palliative radiotherapy or chemotherapy is proposed. Surgical resection associated with chemotherapy or chemoembolization could be an opportunity to improve overall survival and recurrence-free survival in selected cases in a high-volume hepatobiliary center. Moreover, it has been 25 years since Couinaud described the entity of a posterior liver located behind an axial plane crossing the portal bifurcation.

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Background: Laparoscopic liver resection (LLR) can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy. Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization, tumor compression, and bleeding from the short hepatic veins (SHVs). This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava (IVC), allowing SHVs to be addressed after parenchymal transection, thereby reducing surgical complexity and improving outcomes in in situ LLR.

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Clear cell renal cell carcinoma is the predominant subtype of kidney cancer. With distant metastasis, the overall survival rate for patients with renal cell carcinoma decreases significantly compared to localized disease. However, pembrolizumab plus axitinib combination is safe and improves long-term survival.

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surgery and autotransplantation may provide a promising option for radical resection of conventionally unresectable liver tumors. Two cirrhotic patients with hepatocellular carcinoma (HCC), which has an "awkward seat" located in the "intrahepatic vascular triangle area (IVTA)" that consists of the middle hepatic vein (MHV), the right branches of the Glisson sheath, and the inferior vena cava (IVC), underwent extended right-half hepatectomy followed by tumor resection and partial liver autotransplantation. Innovatively, the outflow of the tumor-free liver was reconstructed using pre-frozen allograft blood vessels from brain-dead donors; the patients recovered well postoperation.

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Article Synopsis
  • Primary liver cancer, mainly hepatocellular carcinoma (HCC), is a major cause of cancer deaths, and tumor thrombus (TT) in major vessels worsens patient outcomes.
  • Four male HCC patients (average age 57) with TT in the inferior vena cava or right atrium underwent surgery to remove the tumors, followed by targeted and immunotherapy.
  • All cases show positive outcomes post-treatment, with some patients remaining disease-free for up to 74 months, suggesting that combining surgery with therapy could improve survival rates in advanced HCC patients.
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