Efficacy of a hepatectomy and a tumor thrombectomy for hepatocellular carcinoma with tumor thrombus extending to the main portal vein.
BACKGROUND
Hepatocellular carcinoma (HCC) with major portal tumor thrombus has been considered to be a fatal disease. A thrombectomy remains the only therapeutic option that offer a chance of complete tumor removal avoiding acute portal vein obstruction. However, the efficacy of tumor thrombectomy in addition to hepatectomy has not been well evaluated.


METHODS
Of 979 patients who consecutively underwent initial HCC resection, 45 (4.6%) HCC patients with tumor invasion of the first branch of the portal vein (vp3) and tumor in the main portal trunk or the opposite-side portal branch (vp4) were retrospectively analyzed to evaluate the efficacy of hepatectomy and tumor thrombectomy.


RESULTS
Alpha-fetoprotein, serosal invasion, and intrahepatic metastases were independently significant prognostic factors in all the 45 patients with vp3 or vp4 HCC. The 3- and 5-year survival rates in vp3 and vp4 group were 35.3% and 41.8%, and 21.2% and 20.9%, respectively. There were longer operative times and more intraoperative bleeding in patients with vp4, but no significant difference in mortality, morbidity, and survival between patients with vp3 and vp4.


CONCLUSIONS
Hepatectomy and thrombectomy for vp4 could not only avoid acute portal occlusion due to tumor thrombus but provide a comparable survival benefit with hepatectomy for vp3.
Ban
Daisuke
D
Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Central Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan.
Shimada
Kazuaki
K
Yamamoto
Yusuke
Y
Nara
Satoshi
S
Esaki
Minoru
M
Sakamoto
Yoshihiro
Y
Kosuge
Tomoo
T
D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D012704:Serous Membrane / Q000473:pathology; D017131:Thrombectomy; D020246:Venous Thrombosis / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D000509:alpha-Fetoproteins / Q000032:analysis
D000509:alpha-Fetoproteins