title: Surgical strategy for hepatocellular carcinoma patients with portal vein tumor thrombus based on prognostic factors.
abstract: BACKGROUND
  Surgical strategy for patients with hepatocellular carcinoma and portal vein tumor thrombus (PVTT) remains to be established.
  
  
  METHODS
  From 1990 to 2008, 48 hepatocellular carcinoma patients with PVTT detected by preoperative imaging underwent hepatic resection, and their clinical data were retrospectively analyzed. Possible prognostic factors for survival were analyzed with postoperative survival curves, and significant factors were determined by univariate and multivariate analysis. The frequency of postoperative severe complications was investigated for each prognostic factor.
  
  
  RESULTS
  Significant prognostic factors included patient age <60 years, serum total bilirubin (T-Bil) >0.8 mg/dl, serum aspartate aminotransferase >30 IU/L, serum alkaline phosphatase (ALP) >300 IU/L, tumor size >4 cm, PVTT in the main trunk (Vp4), and a surgical margin <1 mm by univariate analysis, and independent prognostic factors were serum T-Bil, ALP, and Vp4. No patient with Vp4 survived for more than 400 days after surgery, and frequency of postoperative severe complications in these Vp4 patients was significantly higher than in other Vp1-3 patients.
  
  
  CONCLUSIONS
  Hepatic resection as a first-choice treatment should be carefully selected in patients with Vp4 unless emergent removal of the PVTT is required.
authors.affiliation: Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, 5200 Kihara, Kiyotake, Miyazaki 889-1692, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kondo
authors.forename: Kazuo
authors.initials: K
authors.lastname: Chijiiwa
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kai
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Otani
authors.forename: Koki
authors.initials: K
authors.lastname: Nagaike
authors.forename: Jiro
authors.initials: J
authors.lastname: Ohuchida
authors.forename: Masahide
authors.initials: M
authors.lastname: Hiyoshi
authors.forename: Motoaki
authors.initials: M
authors.lastname: Nagano
mesh_terms: D000367:Age Factors; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011169:Portal Vein; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications* / Q000401:mortality / Q000601:surgery*
chemical_list: D001219:Aspartate Aminotransferases; D000469:Alkaline Phosphatase; D001663:Bilirubin