Transabdominal Intrapericardial Approach in Liver Transplantation for Unresectable Primary Hepatic Functioning Paraganglioma With Invasion Into Hepatic Veins and Suprahepatic Vena Cava: A Surgical and Anesthesia Management Challenge

• Published in: Transplantation proceedings 2018-11, Vol.50 (9), p.2630-2635
• Main Authors: Kim, J., Fons, R.A., Scott, J.P., Eriksen, C.M., Lerret, S.M., Browning, M.B., Telega, G.W., Vitola, B.E., Hoffman, G.M., North, P.E., Vo, N.N., Zimmerman, M.A., Hong, J.C.
• Format: Article
• Language: English
• Subjects: Abdominal Wall - surgery; Adolescent; Hepatic Veins - pathology; Hepatic Veins - surgery; Humans; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver Transplantation - methods; Male; Neoplasm Invasiveness; Paraganglioma - pathology; Paraganglioma - surgery; Pericardium - surgery; Venae Cavae - pathology; Venae Cavae - surgery
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2018.02.189

Primary hepatic functional paraganglioma is a rare form of extra-adrenal catecholamine-secreting tumor. Definitive treatment of functioning paraganglioma is challenging because of the critical location of the tumor frequently in close proximity to vital structures and risk of excessive catecholamine release during operative manipulation. We report the multidisciplinary management approach for a case of unresectable primary hepatic functional paraganglioma with invasion into the hepatic veins and suprahepatic vena cava. To our knowledge, this is the first report showing that orthotopic liver transplantation is curative for patients with unresectable primary hepatic paraganglioma. For locally advanced unresectable hepatic paraganglioma that involves the intrapericardial vena cava, a meticulous pre- and intraoperative medical management and transabdominal intrapericardial vascular control of the suprahepatic vena cava during orthotopic liver transplantation allows for complete extirpation of the tumor and achieves optimal outcome. •Orthotopic liver transplantation is a curative treatment for patients with unresectable primary hepatic paraganglioma.•A meticulous pre- and intraoperative medical management of the patient's hemodynamics is crucial during orthotopic liver transplantation for unresectable primary hepatic paraganglioma.•For a tumor invading the suprahepatic inferior vena cava, a transabdominal intrapericardial vascular control of the suprahepatic vena cava during orthotopic liver transplantation allows for a complete extirpation of the tumor and achieves optimal outcome.