title: Surgical treatment for hepatocellular carcinoma with portal vein tumor thrombus: a novel classification.
abstract: BACKGROUND
  The hepatic resection for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) which is not uncommon at clinic continues to be debated. Our study introduced a novel classification of HCC with PVTT and compared the outcomes of surgical treatment between different groups.
  
  
  METHODS
  From January 2008 to December 2012, a total of 56 cases of HCC with PVTT underwent liver resection combined with thrombectomy. Clinical pathological features and surgical data of these patients were retrospectively studied. The patients were divided into two groups. Cumulative overall and disease-free survival curves of the patients were compared according to different groups.
  
  
  RESULTS
  Sixteen patients (28.6%) belonging to group A were compared to 40 patients (71.4%) belonging to group B. The rates of capsular formation and tumor number showed differences between the two groups (P = 0.047, P = 0.032). Group A had more liver cirrhosis than group B (P = 0.047). The patients with large blood loss (≥1,000) were more in group A, as well. There was no significant difference in complications between the two groups except the ascites (P = 0.028). The 1-year overall survival rate of group A after liver resection was 31.5%. The 1-, 3-, and 5-year overall survival rates of group B were 62.3%, 16.1%, and 5.2%, respectively. For further study, group B had significantly better overall survival than group A (P = 0.033). Group A had significantly higher incidence of recurrence than group B (P = 0.021).
  
  
  CONCLUSIONS
  Liver resection combined with thrombectomy for HCC with PVTT can get better outcome in the HCC patients with PVTT involving only one branch (left/right) of portal vein (group B) compared to patients with PVTT involving the main portal vein trunk or both the left and right portal veins (group A).
authors.affiliation: Department of Surgery, The Fourth Affiliated Hospital of Zhejiang, University School of Medicine, East building in Huajiachi campus, Kaixuan road 268, Hangzhou, Zhejiang, 310020, China. zjxujiangfeng@hotmail.com.
authors.forename: Jiang-feng
authors.initials: JF
authors.lastname: Xu
authors.affiliation: Department of Surgery, The Fourth Affiliated Hospital of Zhejiang, University School of Medicine, East building in Huajiachi campus, Kaixuan road 268, Hangzhou, Zhejiang, 310020, China. csuliuxiyu@163.com.
authors.forename: Xi-yu
authors.initials: XY
authors.lastname: Liu
authors.affiliation: Department of Surgery, The Fourth Affiliated Hospital of Zhejiang, University School of Medicine, East building in Huajiachi campus, Kaixuan road 268, Hangzhou, Zhejiang, 310020, China. handsome102@163.com.
authors.forename: Shuai
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Surgery, The Fourth Affiliated Hospital of Zhejiang, University School of Medicine, East building in Huajiachi campus, Kaixuan road 268, Hangzhou, Zhejiang, 310020, China. huaixi@163.com.
authors.forename: Huai-xi
authors.initials: HX
authors.lastname: Wen
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000145:classification / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011169:Portal Vein / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D017131:Thrombectomy; D020246:Venous Thrombosis / Q000150:complications / Q000473:pathology / Q000601:surgery*