Hepatic resection for hepatocellular carcinoma with a tumor thrombus extending to inferior vena cava.

The significance of hepatic resection for hepatocellular carcinoma with a tumor thrombus in the inferior vena cava (IVC) is clarified. We operated on 4 patients with HCC who had a tumor thrombus extending to the IVC through the hepatic vein under hepatic vascular exclusion (HVE). In all patients the hepatic resections and thrombectomies were successful without major complication. One patient accompanied with a tumor thrombus in the portal vein had a rash recurrence in the remnant liver and died 6 months after operation. However, three patients without tumor thrombus in the portal vein survived relatively longer post-operatively. Hepatic resection for HCC with tumor thrombus in IVC is acceptable treatment as it is safe. It is considered that better prognoses can be maintained when a tumor thrombus is located only in the hepatic vein, and not in the portal vein.