title: Surgical outcomes of hepatocellular carcinoma invading hepatocaval confluence.
abstract: BACKGROUND
  Combined liver and inferior vena cava (IVC) resection followed by IVC and/or hepatic vein reconstruction (HVR) is a curative operation for selected patients with hepatocellular carcinoma (HCC) invading the hepatocaval confluence. The present study aimed to elucidate the prognostic factors for patients with HCC invading the hepatocaval confluence.
  
  
  METHODS
  Forty-two consecutive patients underwent hepatectomy, combined with IVC replacement and/or HVR for HCC between January 2009 and December 2014 were included in this study. The cases were divided into three groups based on the surgical approaches of HVR: group 1 (n=13), tumor invaded the hepatocaval confluence but with one or two hepatic veins intact in the residual liver, thus only the replacement of IVC, not HVR; group 2 (n=23), the hepatic vein of the residual liver was also partially invaded, and the hepatic vein defect was repaired with patches locally; group 3 (n=6), three hepatic veins at the hepatocaval confluence were infiltrated, and the hepatic vein remnant was re-implanted onto the side of the tube graft. The patient characteristics, intra- and postoperative results, and long-term overall survival were compared among the three groups. The survival-related factors were analyzed by univariate and multivariate analysis.
  
  
  RESULTS
  The group 1 had higher preoperative alpha-fetoprotein level (P<0.001), shorter operation time, hepatic ischemic time and hospital stay compared with groups 2 and 3 (P<0.05). The 1-, 3-, and 4-year overall survival rates of group 1 were 84.6%, 23.1% and 23.1%, respectively; group 2 were 78.3%, 8.7% and 8.7% respectively and group 3 were 83.3%, 0 and 0, respectively. The multivariate analysis showed that the independent poor prognostic factors of overall survival were preoperative higher HBV DNA level (≥103copies/mL; P=0.001), tumor size (≥9 cm; P<0.0001), age (≥60 years; P=0.010) and underwent HVR (P<0.0001).
  
  
  CONCLUSIONS
  Patients with reconstructing hepatic vein with patches locally (group 2) or to the artificial graft (group 3) had worse long-term survival than those without HVR (group 1). HVR was one of the unfavorable prognostic factors of overall survival.
authors.affiliation: Department of Liver Surgery & Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu 610041, China. Wuhong7801@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Hong
authors.initials: H
authors.lastname: Wu
authors.forename: Jun
authors.initials: J
authors.lastname: Han
mesh_terms: D000328:Adult; D000367:Age Factors; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006503:Hepatic Veins / Q000473:pathology / Q000601:surgery*; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012092:Replantation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014680:Veins / Q000637:transplantation*; D014682:Vena Cava, Inferior / Q000473:pathology / Q000601:surgery*; D019562:Viral Load