title: Surgical treatment of hepatocellular carcinoma with inferior vena cava tumor thrombus: a new classification for surgical guidance.
abstract: BACKGROUND
  Hepatic resection is the main treatment modality for hepatic tumors. Advances in diagnostic technique, preoperative preparation, surgical technique, and postoperative management increased the success rate. The present study aimed to evaluate hepatectomy and resection of inferior vena cava tumor thrombus (IVCTT) in patients with hepatocellular carcinoma, and the relationship between IVCTT classification and selection of surgical technique.
  
  
  METHODS
  We retrospectively reviewed 13 patients with hepatocellular carcinoma who had undergone hepatectomy with IVCTT resection between May 1997 and August 2009. Age, gender, diagnosis, findings of physical examination, results of preoperative laboratory investigations, radiological examination, criteria for resection, postoperative pathological results, incisions, operative technique, intraoperative transfusion, drains, and intraoperative and postoperative complications were evaluated for all patients.
  
  
  RESULTS
  Type I IVCTT (10 patients) was posterior to the liver and below the diaphragm; type II IVCTT (2 patients) was above the diaphragm but still outside the atrium; and type III IVCTT (1 patient) was above the diaphragm and in the right atrium. Type I was treated by radical hepatectomy and removal of IVCTT with total hepatic vascular exclusion. Type II was treated by radical hepatectomy and removal of IVCTT by incision of the diaphragm. Type III was treated by hepatectomy and resection of the thrombus from the right atrium under cardiopulmonary bypass. There were no surgical complications and one patient has been survived for 4 years with cancer-free status. The median survival time was 18.2 months, and the 1- and 2-year survival rates were 53.8% and 15.4%, respectively.
  
  
  CONCLUSIONS
  Surgical treatment is safe and feasible for treatment of IVCTT in patients with hepatocellular carcinoma, and surgical resectability can be judged according to the classification of tumor thrombus.
authors.affiliation: Division of Special Treatment II, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China. qiufujian@sina.com.
authors.forename: Ai-Jun
authors.initials: AJ
authors.lastname: Li
authors.forename: Wei-Ping
authors.initials: WP
authors.lastname: Zhou
authors.forename: Chuan
authors.initials: C
authors.lastname: Lin
authors.forename: Xi-Long
authors.initials: XL
authors.lastname: Lang
authors.forename: Zhen-Guang
authors.initials: ZG
authors.lastname: Wang
authors.forename: Xiao-Yu
authors.initials: XY
authors.lastname: Yang
authors.forename: Qing-He
authors.initials: QH
authors.lastname: Tang
authors.forename: Ran
authors.initials: R
authors.lastname: Tao
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018618:Echocardiography, Doppler, Color; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000145:classification / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*; D020246:Venous Thrombosis / Q000145:classification / Q000401:mortality / Q000473:pathology / Q000601:surgery*