INTRODUCTION: Hepatocellular carcinoma (HCC) with major portal tumor thrombus has been considered to be a fatal disease. A thrombectomy remains the only therapeutic option that offer a chance of complete tumor removal avoiding acute portal vein obstruction. However, the efficacy of tumor thrombectomy in addition to hepatectomy has not been well evaluated. METHODS: Of 979 patients who consecutively underwent initial HCC resection, 45 (4.6%) HCC patients with tumor invasion of the first branch of the portal vein (vp3) and tumor in the main portal trunk or the opposite-side portal branch (vp4) were retrospectively analyzed to evaluate the efficacy of hepatectomy and tumor thrombectomy. RESULTS: Alpha-fetoprotein, serosal invasion, and intrahepatic metastases were independently significant prognostic factors in all the 45 patients with vp3 or vp4 HCC. The 3- and 5-year survival rates in vp3 and vp4 group were 35.3% and 41.8%, and 21.2% and 20.9%, respectively. There were longer operative times and more intraoperative bleeding in patients with vp4, but no significant difference in mortality, morbidity, and survival between patients with vp3 and vp4. CONCLUSION: Hepatectomy and thrombectomy for vp4 could not only avoid acute portal occlusion due to tumor thrombus but provide a comparable survival benefit with hepatectomy for vp3.
INTRODUCTION:Hepatocellular carcinoma (HCC) with major portal tumor thrombus has been considered to be a fatal disease. A thrombectomy remains the only therapeutic option that offer a chance of complete tumor removal avoiding acute portal vein obstruction. However, the efficacy of tumor thrombectomy in addition to hepatectomy has not been well evaluated. METHODS: Of 979 patients who consecutively underwent initial HCC resection, 45 (4.6%) HCC patients with tumor invasion of the first branch of the portal vein (vp3) and tumor in the main portal trunk or the opposite-side portal branch (vp4) were retrospectively analyzed to evaluate the efficacy of hepatectomy and tumor thrombectomy. RESULTS:Alpha-fetoprotein, serosal invasion, and intrahepatic metastases were independently significant prognostic factors in all the 45 patients with vp3 or vp4 HCC. The 3- and 5-year survival rates in vp3 and vp4 group were 35.3% and 41.8%, and 21.2% and 20.9%, respectively. There were longer operative times and more intraoperative bleeding in patients with vp4, but no significant difference in mortality, morbidity, and survival between patients with vp3 and vp4. CONCLUSION: Hepatectomy and thrombectomy for vp4 could not only avoid acute portal occlusion due to tumor thrombus but provide a comparable survival benefit with hepatectomy for vp3.
Authors: J M Llovet; J Bustamante; A Castells; R Vilana; M del C Ayuso; M Sala; C Brú; J Rodés; J Bruix Journal: Hepatology Date: 1999-01 Impact factor: 17.425
Authors: E Villa; A Moles; I Ferretti; P Buttafoco; A Grottola; M Del Buono; M De Santis; F Manenti Journal: Hepatology Date: 2000-08 Impact factor: 17.425
Authors: T Takayama; M Makuuchi; S Hirohashi; M Sakamoto; J Yamamoto; K Shimada; T Kosuge; S Okada; K Takayasu; S Yamasaki Journal: Hepatology Date: 1998-11 Impact factor: 17.425
Authors: Y Yamaoka; K Kumada; K Ino; T Takayasu; Y Shimahara; K Mori; A Tanaka; T Morimoto; Y Taki; M Washida Journal: World J Surg Date: 1992 Nov-Dec Impact factor: 3.352
Authors: Stephen L Chan; Charing C N Chong; Anthony W H Chan; Darren M C Poon; Kenneth S H Chok Journal: World J Gastroenterol Date: 2016-08-28 Impact factor: 5.742