Twelve-Year Survival After Resection of Hepatocellular Carcinoma with Right Atrial Tumor Thrombus.

INTRODUCTION: A large hepatocellular carcinoma (HCC) with macrovascular invasion is generally considered to have poor prognosis due to unfavorable tumor biology andsuch patients are relegated to palliative options. This report describes long term survival after surgery in a patient with HCC and tumor thrombus in the rightatrium. METHODS: Case records of the patient, details of follow up visits and surveillance computed tomography scans performed were reviewed. A brief discussion of thesurgical strategy adopted along with outcome of similar cases in literature is presented. RESULTS: A 60 year old man presented with a HCC in segments 4, 5 with extension of tumor into the middle, left hepatic veins, inferior vena cava and right atrium.Patient underwent extraction of the tumor thrombus from the right atrium under cardiopulmonary bypass along with extended left hepatectomy. He receivedthree cycles of adjuvant chemotherapy with Gemcitabine, Oxaliplatin and Interferon. There was a parietal wall recurrence after 1 year and 10 months whichwas excised. Since then he remains well and is on regular follow up for more than 12 years from his index surgery with no evidence of disease, making himthe longest known survivor with such an advanced presentation. CONCLUSION: This is an unusual instance where aggressive resection for HCC with right atrial tumor thrombus has resulted in an exceptionally long survival.

A technique for gall bladder fundal traction in single-incision laparoscopic cholecystectomy.

INTRODUCTION: The last 2 years have seen numerous reports on single-incision laparoscopic surgery (SILS) in the surgical literature. Achieving an appropriate fundal traction is one among the many technical challenges while performing a SILS cholecystectomy. We describe herein an innovative method of suture traction of gall bladder fundus during SILS cholecystectomy. MATERIALS AND METHODS: Prospective data of patients who underwent SILS cholecystectomy from July 2009 to till date in the Department of Surgical Gastroenterology at Manipal Institute of Liver and Digestive Diseases, Bangalore, were analyzed. RESULTS: Twenty-eight patients, 8 male and 20 female patients, with the age ranging from 24 to 62 years have undergone SILS cholecystectomy for cholelithiasis. The suture technique described herein was performed in the last 25 patients. There was no complication related to the use of this suture technique. CONCLUSIONS: Technological innovations would ultimately find an easier solution for gall bladder retraction in SILS cholecystectomy. Till such time we believe that the suture technique described herein would offer the most satisfactory fundal traction during SILS cholecystectomy and would find application in the vast majority of patients undergoing SILS cholecystectomy. In addition, this technique could be extended for application in a variety of other SILS procedures.