title: Is there any difference in survival according to the portal tumor thrombectomy method in patients with hepatocellular carcinoma?
abstract: BACKGROUND
  Although portal venous tumor thrombus (PVTT) is regarded as an ominous prognostic factor in patients with hepatocellular carcinoma (HCC), the optimal treatment method for maximizing both safety and long-term outcome has not yet been discussed. We describe a surgical technique in which the venous wall is peeled off from the PVTT.
  
  
  METHODS
  In the peeling off (PO) technique, the portal venotomy was placed after adequate vascular control of portal flow. The PVTT was dissected from the portal venous wall and removed through the opening. Macroscopically residual PVTTs intruding into tiny branches were meticulously extracted. This procedure was compared with the en bloc resection of PVTT. Between 1995 and 2006, 49 patients underwent curative hepatic resections for HCC with macroscopic PVTT; these patients were classified according to whether the PO technique (n = 20) or the en bloc technique (n = 29) had been utilized. Both the short- and long-term results were compared between the 2 groups.
  
  
  RESULTS
  No mortalities occurred in either group. Both the 5-year overall survival and the recurrence-free survival rates of the PO group were comparable with those of the en bloc group (39% vs 41% [P = .90] and 23% vs 18% [P = .89], respectively). No local recurrences or regrowth of the PVTT occurred in either group.
  
  
  CONCLUSIONS
  Our procedure is useful for removing PVTT extending beyond the bifurcation or into other sectors that should be preserved in terms of liver function and enables a more conservative resection than an en bloc technique without sacrificing curability.
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Inoue
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Takeaki
authors.initials: T
authors.lastname: Ishizawa
authors.forename: Taku
authors.initials: T
authors.lastname: Aoki
authors.forename: Keiji
authors.initials: K
authors.lastname: Sano
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Beck
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Imamura
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D004210:Dissection; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011169:Portal Vein; D012189:Retrospective Studies; D015996:Survival Rate; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000473:pathology / Q000601:surgery*