Staged caval occlusion enabling en bloc right divisional hepatectomy in two dogs with hepatocellular carcinoma.

OBJECTIVE: To describe staged pre-renal caudal vena cava (CVC) occlusion before en bloc right divisional hepatectomy with segmental caval resection in two dogs with right divisional hepatocellular carcinoma (HCC) involving the CVC. ANIMALS: Two client-owned, 11-year-old neutered male dogs (Siberian Husky and Shih Tzu). STUDY DESIGN: Short case series. METHODS: Dog 1 (Siberian Husky) had prior hemoperitoneum and biopsy-confirmed HCC; dog 2 (Shih Tzu) had persistent liver enzyme elevations and a suspected hepatic tumor. Computed tomography (CT) showed right divisional masses (91.8 × 122.3 × 101.4 mm; 77.0 × 94.8 × 70.2 mm) with CVC compression or involvement and no pre-existing collateral venous return. A percutaneously controlled hydraulic occluder was placed around the pre-renal CVC. Gradual outpatient occlusion was performed over 79 and 44 days while monitoring saphenous venous pressure, renal values, and hindlimb edema. Complete CVC occlusion and collateralization were confirmed by CT before en bloc right divisional hepatectomy with segmental CVC resection. RESULTS: Macroscopically complete resection was achieved in both dogs. Complete HCC resection was confirmed histopathologically. Morbidity was limited to transient wound exudation in dog 1 and transient ascites in dog 2. No recurrence or metastasis was identified in dog 1 during follow-up. In dog 2, no clinical signs suggestive of recurrence or metastasis were reported. Survival after hepatectomy was 352 and 2467 days. CONCLUSION: Staged pre-renal CVC occlusion may establish collateral venous return and permit planned en bloc right divisional hepatectomy with segmental CVC resection in carefully selected dogs with right divisional HCC involving the CVC.