ArticleAME case reports2026
Real-time transesophageal echocardiography-guided surgical resection of hepatocellular carcinoma with inferior vena cava tumor thrombus: a case report.
Article in AME case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Hepatocellular carcinoma (HCC) with tumor thrombus extending into the inferior vena cava (IVC) represents an advanced stage of disease and is associated with a poor prognosis. Surgical resection combined with thrombectomy remains a potentially curative option but carries substantial perioperative risk. Intraoperative transesophageal echocardiography (TEE) provides real-time imaging that may improve procedural safety and surgical precision. Case Description: We report the case of a 49-year-old woman with advanced HCC complicated by tumor thrombus extending from the left portal vein and left hepatic vein into the IVC, with intermittent prolapse toward the right atrium. Preoperative assessment showed Child-Pugh class A liver function (score 6), an Eastern Cooperative Oncology Group (ECOG) performance status of 2, chronic hepatitis B infection without prior antiviral therapy, and preserved coagulation function. Imaging demonstrated cirrhosis and splenomegaly. The patient underwent left hemihepatectomy with IVC tumor thrombectomy under continuous intraoperative TEE guidance. TEE enabled dynamic assessment of thrombus mobility, guided repositioning of the thrombus from the right atrium into the IVC, informed the clamping strategy, and allowed immediate detection of acute bland thrombus formation after vascular repair. Prompt re-intervention was undertaken, and IVC patency was successfully restored. Histopathology confirmed moderately to poorly differentiated HCC with vascular invasion and tumor thrombus [pT4N0M0, American Joint Committee on Cancer (AJCC) 8th edition]. Postoperatively, the patient developed intrahepatic recurrence and received transcatheter arterial chemoembolization (TACE) and targeted therapy. At 12-month follow-up, no recurrence of IVC tumor thrombus was detected. Conclusions: This case highlights the value of anesthesiologist-led intraoperative TEE in complex oncovascular surgery. Continuous TEE guidance facilitated key vascular maneuvers, supported real-time intraoperative decision-making, and enabled early recognition of a potentially life-threatening complication. TEE should be considered an important intraoperative navigation tool in high-risk HCC thrombectomy.
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