Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2016; 22(22): 5297-5300
Published online Jun 14, 2016. doi: 10.3748/wjg.v22.i22.5297
Application of cystoscope in surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus
Nan Li, Xu-Biao Wei, Shu-Qun Cheng
Nan Li, Xu-Biao Wei, Shu-Qun Cheng, Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200433, China
Author contributions: Cheng SQ designed the report and carried out the operation; Li N and Wei XB collected the clinic data and wrote the paper; Li N and Wei XB contributed equally to the article.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of Eastern Hepatobiliary Surgery Hospital.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shu-Qun Cheng, MD, Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, 168 Changhai Road, Yangpu District, Shanghai 200433, China. chengshuqun@aliyun.com
Telephone: +86-211-3901746 Fax: +86-218-1875251
Received: February 7, 2016
Peer-review started: February 7, 2016
First decision: January 13, 2016
Revised: March 6, 2016
Accepted: April 7, 2016
Article in press: April 7, 2016
Published online: June 14, 2016
Processing time: 178 Days and 14.2 Hours
Abstract

Development of portal vein tumor thrombus deteriorates the prognosis of hepatocellular carcinoma, while surgical treatment can offer a promising prognosis for selected patients. However, the possibility of residual lesions in portal vein after conventional thrombectomy is a main risk factor leading to postoperative recurrence. Therefore, ensuring the complete removal of tumor thrombus during operation is critical to improve prognosis. For the first time, we report here one case of hepatocellular carcinoma with portal vein tumor thrombus in which cystoscope was successfully applied as a substitute of intravascular endoscope to visualize the cavity of the portal vein. The patient was a 61-year-old man with a 7-cm tumor in the right lobe of the liver, with tumor thrombus invading the right branch and adjacent to the conjunction of the portal vein. After removal of the tumor, the Olympus CYF-VA2 cystoscope was used to check the portal vein from the opening stump of the right branch of the portal vein. In this case, residual thrombus tissue was found near the opening stump and the conjunction of the portal vein. The residual lesion was carefully retrieved from the stump after retraction of the cystoscope. The procedure was repeated until no residual lesion was found. The whole duration time of thrombectomy was 22.5 (15 + 7.5) min. The patient was free from recurrence at 8 months after the procedure. Our work indicated that the cystoscope is a suitable substitute, with a proper size and function to check the portal vein system and ensure the curability of thrombectomy. Although well-designed clinic trails are still needed, this procedure may further improve the postoperative prognosis of hepatocellular carcinoma with portal vein tumor thrombus.

Keywords: Hepatocellular carcinoma; Portal vein tumor thrombus; Surgical treatment; Thrombectomy; Cystoscope

Core tip: Inability to ensure the curability of the thrombectomy has been a main obstacle to improving postoperative prognosis of hepatocellular carcinoma with portal vein tumor thrombus, especially for cases with invasion in the main trunk of the portal vein. In this report, we firstly applied the cystoscope as an intravascular endoscope to investigate the cavity of the portal vein after primary tumor removal. The cystoscope offered a clear view of the portal vein cavity from the main trunk to the secondary branch, indicating its suitability as a substitute with a proper size and function to check the portal vein system.