Efficacy of a hepatectomy and a tumor thrombectomy for hepatocellular carcinoma with tumor thrombus extending to the main portal vein.

Abstract

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: Daisuke Ban, Kazuaki Shimada, Yusuke Yamamoto, Satoshi Nara, Minoru Esaki, Yoshihiro Sakamoto, Tomoo Kosuge
• Journal: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (J Gastrointest Surg) Vol. 13 Issue 11 Pg. 1921-8 (Nov 2009) ISSN: 1873-4626 [Electronic] United States
• PMID: 19727969 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• alpha-Fetoproteins

Topics

• Carcinoma, Hepatocellular (complications, pathology, surgery)
• Female
• Hepatectomy (methods)
• Humans
• Kaplan-Meier Estimate
• Liver Neoplasms (complications, pathology, surgery)
• Male
• Middle Aged
• Portal Vein (pathology, surgery)
• Retrospective Studies
• Serous Membrane (pathology)
• Thrombectomy
• Venous Thrombosis (etiology, pathology, surgery)
• alpha-Fetoproteins (analysis)