• Tuerhongjiang Tuxun, Shadike Apaer, Gang Yao, Zhipeng Wang, Shensen Gu, Qi Zeng, Aidan Aizezijiang, Jing Wu, Nuerzhatijiang Anweier, Jinming Zhao, and Tao Li.
• Department of Liver Transplantation & Laparoscopic Surgery, Center of Organ Transplantation, The 1st Affiliated Hospital of Xinjiang Medical University.
• Medicine (Baltimore). 2021 May 14; 100 (19): e25780.

RationaleHepatocellular with tumor thrombi extending into 3 hepatic veins (HVs) and right atrium presents as a real clinical challenge. We report the first documented case of surgical resection of an advanced hepatocellular carcinoma (HCC) with extensive invasion to distal stomach, atrium and hepatic vasculatures.Patient ConcernsWe present a case of 48-years old man with abdominal mass accompanying shortness of breath after activities.DiagnosesPreoperative examination revealed giant HCC with tumor thrombi extending into portal vein, HVs, inferior vena cava, and atrium.InterventionsDistal stomach involvement was confirmed at surgery and, distal gastrectomy, atrial reconstruction and ante-situm liver resection and autotransplantation under cardio-pulmonary bypass were performed.OutcomesThe operation time was 490 minutes, extracorporeal circulation time 124 minutes, and anhepatic time 40 minutes. Postoperative follow-up revealed normal hepatic and cardiac function with no sign of recurrence.LessonsThis case illustrates that the extensive invasion of HCC to major vasculature and adjacent organs may not necessarily preclude the liver autotransplantation with multi-visceral resection as the treatment option of extremely advanced HCC patients.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

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