Resection of hepatocellular carcinoma with a tumor thrombus extending into the right atrium

Hepatocellular carcinoma (HCC) extending into the right atrium has generally been considered to represent the terminal stage of the disease. Importantly, this condition also poses the risk of sudden death caused by pulmonary embolism and right heart failure. Surgical removal of the intra-cardiac tumor thrombus appears to be a promising approach to prevent such a disaster. A 54-year-old man underwent extended left hepatectomy with removal of a right atrial tumor thrombus under extracorporeal circulation. The patient had an uneventful postoperative course and is alive, but with bone metastases and intrahepatic recurrence, 12 months after the opearation. We reviewed 18 Japanese cases who underwent surgical removal of right atrial HCC thrombi. All the cases had an uneventful postoperative course, and their mean survival was 11 months (range; 29 days to<gt>4 years) after the operation. Three cases in which total resection of the tumor including the primary HCC are performed, remained alive for more than 2 years after the operation. Thus, surgical removal of an intracardiac tumor thrombus is a feasible and safe procedure. Although HCCs with intra-atrial tumor thrombi seem to be at a far advanced stage, total resection of the tumor including the primary HCC is of primary importance to achieve a favorable outcome.