In hepatocellular carcinoma (HCC) with thrombus formation in the major vasculature, to control unexpected life-threatening progression due to tumor extension into the inferior vena cava (IVC), ensure long-term survival, and improve quality of life (QOL), aggressive surgical approaches can be selectively adopted. We utilized outstanding living donor liver transplant (LDLT) techniques to develop an alternative surgical procedure with new concepts in large HCCs with tumor thrombi that have

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... into the supra-hepatic IVC from the right hepatic vein (RHV) and middle hepatic vein (MHV). A 42-year-old man with a 10-cm HCC in the right lobe was transferred. We found tumor thrombi growing into the supra-hepatic IVC through the RHV, and a tumor thrombus that extended into the MHV through V8 was observed. Surgically, we first procured the left lobe, which had no involvement of the tumor or tumor thrombi, to avoid the spread of tumor thrombi. After securing an adequate operation field, a total hepatectomy was performed with simultaneous total hepatic vascular exclusion. The LDLT technique with modified extended left lobe graft after MHV reconstruction was used for auto-transplantation. Conclusively, this technique with new concepts for auto-transplantation offered our patient the potential to receive subsequent multidisciplinary treatments and an opportunity for improved QOL. Abbreviations: AFP: alpha fetoprotein; CT: computed tomography; HCC: hepatocellular carcinoma; IVC: inferior vena cava; LDLT: living donor liver transplantation; MHV: middle hepatic vein; LHV: left hepatic vein; 18 F FDG-PET/CT: 18 F fluorodeoxyglucose positron emission tomography/computed tomography Han YS (2017) In-vivo hepatic procurement of tumor-free section followed by autotransplantation for large hepatocellular carcinoma with tumor thrombi extending into the inferior vena cava Volume 10(3): 2-4