Surgical Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
The role of liver resection in patients with hepatocellular carcinoma (HCC) accompanying with portal vein tumor thrombus (PVTT) remains controversial. This article aimed to evaluate the significance of different location and extent of PVTT on surgical outcomes after liver resection for HCC.
Materials and Methods
A retrospective study was carried out on patients who underwent partial hepatectomy with or without portal thrombectomy for HCC with PVTT in a single tertiary center from January 2001 to December 2003. According to the extent, PVTT was divided into 4 types (I-segmental/sectoral branches of portal vein, II-left and/or right portal vein, III-main portal vein trunk, and IV-superior mesenteric vein).
A total of 406 patients with HCC and PVTT who underwent partial hepatectomy were studied. The complication rate and hospital mortality rate were 32.8 and 0.2%, respectively. After a median follow-up of 6.4 months, 128 patients (31.5%) died. The 1- and 3-year overall survival rates were 34.4 and 13.0%, respectively. The 1- and 3-year disease-free survival rates were 13.3 and 4.7%, respectively. Patients with PVTT located in the segmental, sectoral, or right and/or left portal veins (types I and II) showed significantly better survival than those with PVTT extended to the main trunk of the portal vein or the superior mesenteric vein (types III and IV).
Liver resection is justified in selected patients with PVTT located in the segmental or sectoral branches of the portal vein. However, surgical resection for PVTT involving the portal bifurcation or the main trunk is still controversial.
- Lau WY. Primary hepatocellular carcinoma. In: Blumgart LH, Fong Y, eds., Surgery of the Liver and Biliary Tract Volume II. 3rd ed. London: W.B. Saunders, 2000;1423–50.
- Lau WY. Management of hepatocellular carcinoma. J R Coll Surg Edinb. 2002;47:389–99.
- Lai EC, Lau WY. The continuing challenge of hepatic cancer in Asia. Surgeon. 2005;3:210–5. CrossRef
- Lau WY, Lai EC, Yu SC. Management of portal vein tumor thrombus. In: Lau WY. Hepatocellular Carcinoma. Singapore: World Scientific Publishing Co. Pte. Ltd. 2008;739–60. CrossRef
- Cheng SQ, Wu MC, Chen H, Shen F, Yang JH, Ding GH, et al. Tumor thrombus types influence the prognosis of hepatocellular carcinoma with the tumor thrombi in the portal vein. Hepatogastroenterology. 2007;54:499–502.
- Ohkubo T, Yamamoto J, Sugawara Y, Shimada K, Yamasaki S, Makuuchi M, et al. Surgical results for hepatocellular carcinoma with macroscopic portal vein tumor thrombosis. J Am Coll Surg. 2000;191:657–60. CrossRef
- Wu CC, Hsieh SR, Chen JT, Ho WL, Lin MC, Yeh DC, et al. An appraisal of liver and portal vein resection for hepatocellular carcinoma with tumor thrombi extending to portal bifurcation. Arch Surg. 2000;135:1273–9. CrossRef
- Konishi M, Ryu M, Kinoshita T, Inoue K. Surgical treatment of hepatocellular carcinoma with direct removal of the tumor thrombus in the main portal vein. Hepatogastroenterology. 2001;48:1421–4.
- Pawlik TM, Poon RT, Abdalla EK, Ikai I, Nagorney DM, Belghiti J, et al. Hepatectomy for hepatocellular carcinoma with major portal or hepatic vein invasion: results of a multicenter study. Surgery. 2005;137:403–10. CrossRef
- Chen XP, Qiu FZ, Wu ZD, Zhang ZW, Huang ZY, Chen YF, et al. Effects of location and extension of portal vein tumor thrombus on long-term outcomes of surgical treatment for hepatocellular carcinoma. Ann Surg Oncol. 2006;13:940–6. CrossRef
- Ikai I, Hatano E, Hasegawa S, Fujii H, Taura K, Uyama N, et al. Prognostic index for patients with hepatocellular carcinoma combined with tumor thrombosis in the major portal vein. J Am Coll Surg. 2006;202:431–8. CrossRef
- Le Treut YP, Hardwigsen J, Ananian P, Saisse J, Gregoire E, Richa H, et al. Resection of hepatocellular carcinoma with tumor thrombus in the major vasculature. A European case-control series. J Gastrointest Surg. 2006;10:855–62. CrossRef
- Fujii T, Takayasu K, Muramatsu Y, Moriyama N, Wakao F, Kosuge T, et al. Hepatocellular carcinoma with portal tumor thrombus: analysis of factors determining prognosis. Jpn J Clin Oncol. 1993;23:105–9.
- Kondo K, Chijiiwa K, Kai M, Otani K, Nagaike K, Ohuchida J, et al. Surgical strategy for hepatocellular carcinoma patients with portal vein tumor thrombus based on prognostic factors. J Gastrointest Surg. 2009;13:1078–83. CrossRef
- Adachi E, Maeda T, Kajiyama K, Kinukawa N, Matsumata T, Sugimachi K, et al. Factors correlated with portal venous invasion by hepatocellular carcinoma: univariate and multivariate analyses of 232 resected cases without preoperative treatments. Cancer. 1996;77:2022–31. CrossRef
- Zhou J, Tang ZY, Wu ZQ, Zhou XD, Ma ZC, Tan CJ, et al. Factors influencing survival in hepatocellular carcinoma patients with macroscopic portal vein tumor thrombosis after surgery, with special reference to time dependency: a single-center experience of 381 cases. Hepatogastroenterology. 2006;53:275–80.
- Sakata H, Konishi M, Ryu M, Kinoshita T, Satake M, Moriyama N, et al. Prognostic factors for hepatocellular carcinoma presenting with macroscopic portal vein tumor thrombus. Hepatogastroenterology. 2004;51:1575–80.
- Li Q, Wang J, Sun Y, Cui YL, Juzi JT, Li HX, et al. Efficacy of postoperative transarterial chemoembolization and portal vein chemotherapy for patients with hepatocellular carcinoma complicated by portal vein tumor thrombosis—a randomized study. World J Surg. 2006;30:2004–11. CrossRef
- Minagawa M, Makuuchi M, Takayama T, Ohtomo K. Selection criteria for hepatectomy in patients with hepatocellular carcinoma and portal vein tumor thrombus. Ann Surg. 2001;233:379–84. CrossRef
- Niguma T, Mimura T, Tutui N. Adjuvant arterial infusion chemotherapy after resection of hepatocellular carcinoma with portal thrombosis: a pilot study. J Hepatobiliary Pancreat Surg. 2005;12:249–53. CrossRef
- Fan J, Zhou J, Wu ZQ, Qiu SJ, Wang XY, Shi YH, et al. Efficacy of different treatment strategies for hepatocellular carcinoma with portal vein tumor thrombosis. World J Gastroenterol. 2005;11:1215–9.
- Tanaka A, Morimoto T, Yamaoka Y. Implications of surgical treatment for advanced hepatocellular carcinoma with tumor thrombi in the portal vein. Hepatogastroenterology. 1996;43:637–43.
- Minagawa M, Makuuchi M. Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus. World J Gastroenterol. 2006;12:7561–7.
- Lau WY, Lai EC. Salvage surgery following downstaging of unresectable hepatocellular carcinoma—a strategy to increase resectability. Ann Surg Oncol. 2007;14:3301–9. CrossRef
- Lau WY, Lai EC The current role of radiofrequency ablation in the management of hepatocellular carcinoma: a systematic review. Ann Surg. 2009;249:20–5. CrossRef
- Lau WY, Yu SC, Lai EC, Leung TW. Transarterial chemoembolization for hepatocellular carcinoma. J Am Coll Surg. 2006;202:155–68. CrossRef
- Lau WY, Ho SK, Yu SC, Lai EC, Liew CT, Leung TW. Salvage surgery following downstaging of unresectable hepatocellular carcinoma. Ann Surg. 2004;240:299–305. CrossRef
- Surgical Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus
Annals of Surgical Oncology
Volume 17, Issue 8 , pp 2073-2080
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China
- 2. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China