A case of hepatocellular carcinoma resected after improvement of liver function by balloon-occluded retrograde transvenous obliteration

Hepatocellular carcinoma with liver cirrhosis is often unresectable due to liver dysfunction. A 82-year-old man had two hepatocellular carcinomas measuring 2.5cm at S6 and 1cm at S8 of the liver. Despite transcatheter arterial chemoembolization (TACE) for these carcinomas, local recurrence was seen at S6, TACE repeated, and local recurrence seen again. He had severe liver dysfunction (Child-Pugh 8 ; Grade B, and liver damage C) and a huge gastro-renal shunt. Balloon-occluded retrograde transvenous obliteration (B-RTO) was conducted to increase portal flow to the liver and improve liver function. After B-RTO, liver function improved to Child-Pugh 6 ; Grade A, and liver damage B. Partial hepatic resection (S6) was successful and the man was discharged on postoperative day 14 without postoperative complications. The obliteration of portosystemic shunt using B-RTO makes it possible to conduct hepatic resection for hepatocellular carcinoma in patients with severe liver dysfunction. This strategy is especially useful in the treatment of TACE resistant carcinoma.