A CASE OF RESECTION UNDER THE IVC-ATRIAL VENOVENOUS BYPASS OF A HEPATOBLASTOMA AFTER INTRAARTERIAL CHEMOTHERAPY

An 11-month-old infant with a huge hepatoblastoma occupying almost the entire liver was admitted to the hospital. Serum alpha fetoprotein (A FP) level was elevated to 685,120 ng/mL. Combination chemotherapy with continuous arterial infusion of tetrahydropyranyl Adriamycin (THP-Adr iamycin) and cisplatin based on the 91B1 protocol of the Japanese Stud y Group For Pediatric Liver Tumor (JPLT) was administered as the adjuv ant chemotherapy. The tumor responded to three courses of chemotherapy and shrank in size, although venocavography showed that the inferior vena cava (IVC) was completely occluded below the entry of the hepatic veins. Right hepatic trisegmentectomy was performed with an IVC-atria l venovenous bypass that prevented massive bleeding. In this case, it was recognized that the IVC-atrial venovenous bypass was advantageous in an infant. The procedure is very simple and the blood flow obtained by the bypass was sufficient. Two weeks postoperatively, three course s of chemotherapy were initiated after the protocol. The patient remai ns well without signs of recurrence 39 months postoperatively, and the AFP value has remained within 10 ng/mL. Copyright (C) 1998 by W.B. Sa unders Company.