Surgical management of hepatocellular carcinoma after Fontan procedure

Steve Kwon, Lauren Scovel, Matthew Yeh, David Dorsey, Gregory Dembo, Eric V. Krieger, Ramassmy Bakthavatsalam, James O. Park, Kevin M. Riggle, Kimberly J. Riehle, Raymond S. Yeung

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33 Scopus citations

Abstract

The Fontan operation has successfully prolonged the lives of patients born with single-ventricle physiology. A long-term consequence of post-Fontan elevation in systemic venous pressure and low cardiac output is chronic liver inflammation and cirrhosis, which lead to an increased risk of hepatocellular carcinoma (HCC). Surgical management of patients with post-Fontan physiology and HCC is challenging, as the requirement for adequate preload in order to sustain cardiac output conflicts with the low central venous pressure (CVP) that minimizes blood loss during hepatectomy. Consequently, liver resection is rarely performed, and most reports describe nonsurgical treatments for locoregional control of the tumors in these patients. Here, we present a multidisciplinary approach to a successful surgical resection of a HCC in a patient with Fontan physiology.

Original languageEnglish
Pages (from-to)E55-E60
JournalJournal of Gastrointestinal Oncology
Volume6
Issue number3
DOIs
StatePublished - 2015
Externally publishedYes

Keywords

  • Fontan
  • Hepatectomy
  • Hepatocellular carcinoma (HCC)
  • Resection
  • Single ventricle

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