title: Strategy of treatment for hepatocellular carcinomas with vascular infiltration in patients undergoing hepatectomy.
abstract: OBJECTIVE
  Vascular infiltration (VI) is an important prognostic factor for hepatocellular carcinoma (HCC) and predictive parameters are necessary to preoperatively decide treatment strategies in patients with HCC.
  
  
  METHODS
  Relationships between presence and degree of VI in the portal and hepatic veins and bile duct, and post-hepatectomy survival were examined in 271 HCC patients who underwent hepatectomy.
  
  
  RESULTS
  VI was observed in 81 patients (30%). Disease-free and overall survival rates was significantly lower in patients with VI than in patients without VI, and became poorer according to the degree of infiltration (P < 0.01). Multiple, increased size, non-meeting of Milan criteria, irregular macroscopic findings and increased PIVKA-II levels were associated with degree of VI in portal vein (P < 0.01). Increased size and increased PIVKA-II level were associated with degree of VI in hepatic vein (P < 0.05). Non-meeting of Milan criteria was associated with degree of infiltration in bile duct (P = 0.034). Survival was significantly better following anatomical resection than with non-anatomical resection and, furthermore, survival was better with surgical margins >5 mm than with shorter margins in patients who underwent non-anatomical resection.
  
  
  CONCLUSIONS
  Adequate extent of operative procedures, but not limited resection with short margins, is useful when predictive parameters associated with VI are observed.
authors.affiliation: Division of Surgical Oncology, Hepatology, Nagasaki University Hospital, Nagasaki, Japan. a-nanasm@alpha.med.nagasaki-u.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.forename: Syuuichi
authors.initials: S
authors.lastname: Tobinaga
authors.forename: Masaki
authors.initials: M
authors.lastname: Kunizaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Miuma
authors.forename: Naota
authors.initials: N
authors.lastname: Taura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takeshita
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Hidaka
authors.forename: Terumitsu
authors.initials: T
authors.lastname: Sawai
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakao
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000378:metabolism; D006801:Humans; D007564:Japan; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D018579:Patient Selection; D011169:Portal Vein / Q000378:metabolism; D011379:Prognosis; D011498:Protein Precursors / Q000097:blood; D011516:Prothrombin; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D011498:Protein Precursors; C008208:acarboxyprothrombin; D011516:Prothrombin