Treatment of portal vein tumor thrombus of hepatocellular carcinoma with percutaneous laser ablation.
BACKGROUND
Portal vein tumor thrombus (PVTT) is a common complication of hepatocellular carcinoma (HCC), and is associated with extremely poor prognosis.


METHODS
In this retrospective study, we first evaluate the application of percutaneous laser ablation as a treatment for PVTT due to advanced hepatocellular carcinoma. 108 patients (2002.7-2005.12) that have adequate liver function and be in reasonably good general condition were enrolled at Eastern hepatobiliary surgery hospital. The thrombus was ablated via an optic fiber placed in the guide needle with the guiding of ultrasound. In the follow-ups, the serial imaging and laboratory routines were examined and the overall clinical progress was measured at regular intervals until time of death. In the clinical assessment, survival time and factors affecting survival time were analyzed. The changes of laboratory test (alanine transaminase and alpha fetoprotein) and clinical manifestation (ascites and diarrhea) of the PVTT patients before and after laser ablation were observed.


RESULTS
Patency of the tumor-occluded portal vein branch is the only factor that affect the survival time, the longer the patency time, the longer the survival time. The long-term survivals of patients in our study are 55.56, 33.58 and 22.38% at 1, 2 and 3 years, respectively. Both laboratory test and clinical presentations were improved. Alphalpha fetoprotein in the positive patients decreased and alanine transaminase in the abnormal patients normalized at 1 month after the treatment. Ascites disappeared in 44.00% patients (11/25), and diarrhea ameliorated in 57.14% (12/21).


CONCLUSIONS
Laser ablation might be a novel and effective treatment for PVTT associated with advanced HCC.
Lu
Zheng-Hua
ZH
Department of Ultraphonic Diagnosis, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
Shen
Feng
F
Yan
Zhen-Lin
ZL
Li
Jun
J
Yang
Jia-He
JH
Zong
Ming
M
Shi
Le-Hua
LH
Wu
Meng-Chao
MC
D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D005260:Female; D005334:Fever / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000379:methods*; D008113:Liver Neoplasms / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D020246:Venous Thrombosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D000509:alpha-Fetoproteins / Q000032:analysis
D000509:alpha-Fetoproteins; D000410:Alanine Transaminase