Surgical treatment of hepatocellular carcinoma with portal vein tumor thrombus.
BACKGROUND
The role of liver resection in patients with hepatocellular carcinoma (HCC) accompanying with portal vein tumor thrombus (PVTT) remains controversial. This article aimed to evaluate the significance of different location and extent of PVTT on surgical outcomes after liver resection for HCC.


METHODS
A retrospective study was carried out on patients who underwent partial hepatectomy with or without portal thrombectomy for HCC with PVTT in a single tertiary center from January 2001 to December 2003. According to the extent, PVTT was divided into 4 types (I-segmental/sectoral branches of portal vein, II-left and/or right portal vein, III-main portal vein trunk, and IV-superior mesenteric vein).


RESULTS
A total of 406 patients with HCC and PVTT who underwent partial hepatectomy were studied. The complication rate and hospital mortality rate were 32.8 and 0.2%, respectively. After a median follow-up of 6.4 months, 128 patients (31.5%) died. The 1- and 3-year overall survival rates were 34.4 and 13.0%, respectively. The 1- and 3-year disease-free survival rates were 13.3 and 4.7%, respectively. Patients with PVTT located in the segmental, sectoral, or right and/or left portal veins (types I and II) showed significantly better survival than those with PVTT extended to the main trunk of the portal vein or the superior mesenteric vein (types III and IV).


CONCLUSIONS
Liver resection is justified in selected patients with PVTT located in the segmental or sectoral branches of the portal vein. However, surgical resection for PVTT involving the portal bifurcation or the main trunk is still controversial.
Shi
Jie
J
Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China.
Lai
Eric C H
EC
Li
Nan
N
Guo
Wei-Xing
WX
Xue
Jie
J
Lau
Wan Yee
WY
Wu
Meng-Chao
MC
Cheng
Shu-Qun
SQ
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008641:Mesenteric Vascular Occlusion / Q000601:surgery*; D008642:Mesenteric Veins / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D017131:Thrombectomy / Q000009:adverse effects; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000401:mortality / Q000601:surgery*