Liver resection with thrombectomy as a treatment of hepatocellular carcinoma with major vascular invasion: results from a retrospective multicentric study.
BACKGROUND
The role of liver resection (LR) of hepatocellular carcinoma with macroscopic vascular thrombosis (MVT) remains controversial. The aim of this study is to evaluate whether the presence of MVT should still be considered a contraindication for LR.


METHODS
Retrospective study was carried out on 62 patients who underwent LR and thrombectomy for hepatocellular carcinoma complicated by MVT. Of the 62 patients, 15 (36.5%) had tumor thrombus (TT) in the peripheral portal vein (Vp1), 5 (12.2%) in second branch (Vp2), and 21 (51.3%) in the first branch/portal vein trunk (Vp3), while on the hepatic/cava vein side, 8 (12.9%) had TT in the main trunk of the hepatic veins (Vv2) and 3 (4.8%) had TT reaching the vena cava/right atrium (Vv3).


RESULTS
Perioperative major morbidity was 14.5%, while in-hospital mortality was 4.8%. Overall, 1, 3, and 5-year survival rates were 53.3%, 30.1%, and 20%, and disease-free survival rates were 31.7%, 20.8%, and 15.6%, respectively. There were no differences in survival about the MVT localized in Vp1, Vp2, or Vp3 (P = .77), while we found a statistical trend between patients with Vv2 and Vv3 (P = .06).


CONCLUSIONS
Surgical resection seems to be justified in these patients, and the presence of MVT should no longer be considered an absolute contraindication for LR.
Gastrointestinal Surgery Unit, Department of Surgery and Translational Medicine, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy.
Benedetta
B
Pesi
Department of HPB and Digestive Surgery, Mauriziano Umberto I Hospital, Turin, Italy.
Alessandro
A
Ferrero
Liver Surgery and Transplantation Unit, Department of Emergency, Surgery and Transplants, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Gianluca L
GL
Grazi
Liver Surgery and Transplantation Unit, Department of Emergency, Surgery and Transplants, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Matteo
M
Cescon
Department of HPB and Digestive Surgery, Mauriziano Umberto I Hospital, Turin, Italy.
Nadia
N
Russolillo
Gastrointestinal Surgery Unit, Department of Surgery and Translational Medicine, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy.
Francesca
F
Leo
Department of Oncology/Core Research Laboratory, Careggi University Hospital, Florence, Italy.
Luca
L
Boni
Liver Surgery and Transplantation Unit, Department of Emergency, Surgery and Transplants, S. Orsola-Malpighi University Hospital, Bologna, Italy.
Antonio D
AD
Pinna
Department of HPB and Digestive Surgery, Mauriziano Umberto I Hospital, Turin, Italy.
Lorenzo
L
Capussotti
Gastrointestinal Surgery Unit, Department of Surgery and Translational Medicine, Careggi University Hospital, Largo Brambilla 3, Florence 50134, Italy. Electronic address: g.batignani@unifi.it.
Giacomo
G
Batignani
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000556:secondary* / Q000601:surgery*; D018572:Disease-Free Survival; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009360:Neoplastic Cells, Circulating; D012189:Retrospective Studies; D015996:Survival Rate; D017131:Thrombectomy; D055815:Young Adult
Hepatocellular carcinoma; Liver resection; Macroscopic vascular thrombosis; Major vascular invasion; Multicentric study; Thrombectomy