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Impact of Hepatectomy for Advanced Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombus

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Optimal treatment strategies for advanced hepatocellular carcinoma (HCC) with macroscopic portal vein tumor thrombus (PVTT) remain controversial. Therefore, this study aimed to assess the impact and predictive factors of hepatectomy for HCC with macroscopic PVTT.

Methods

This study included 100 patients who presented with intraoperatively confirmed PVTT extending to the first portal branch (Vp3), main portal trunk, or opposite-side portal branch (Vp4) between June 2000 and December 2019. Their postoperative outcomes and predictive factors for survival were evaluated.

Results

Of the 100 patients, 37 (37%) and 63 (63%) had Vp3 and Vp4 PVTTs, respectively. Moreover, 42 (42%) and 58 (58%) patients underwent R0/1 and R2 hepatectomies, respectively. The median survival time (MST) of all patients with Vp3/4 PVTT was 14.5 months; the 1- and 3-year overall survival rates were 59.6 and 16.8%, respectively. The MSTs of patients with Vp3 and Vp4 PVTTs were 16.1 and 14.3 months, respectively (P = 0.7098). The MSTs of patients who underwent R0/1 and R2 hepatectomies were 14.3 and 14.9 months, respectively (P = 0.3831). All assessed tumor factors (including the Vp status [Vp3 or Vp4], type of resection [R0/1 or R2], intrahepatic maximal tumor size, intrahepatic tumor number, and the existence of extrahepatic metastasis) did not influence the overall survival significantly.

Conclusions

Tumor factors, such as the presence of a Vp3/4 PVTT, have a strong impact on survival; however, other multiple tumor factors have a limited impact. Hepatectomy can be an effective treatment option for HCC with Vp3/4 PVTT, and its indications should be considered.

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Authors and Affiliations

  1. Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan

    Shohei Komatsu, Masahiro Kido, Kaori Kuramitsu, Daisuke Tsugawa, Hidetoshi Gon, Kenji Fukushima, Takeshi Urade, Hiroaki Yanagimoto, Hirochika Toyama & Takumi Fukumoto

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  1. Shohei Komatsu
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  2. Masahiro Kido
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  3. Kaori Kuramitsu
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  4. Daisuke Tsugawa
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  5. Hidetoshi Gon
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  6. Kenji Fukushima
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  7. Takeshi Urade
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  8. Hiroaki Yanagimoto
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  9. Hirochika Toyama
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  10. Takumi Fukumoto
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Contributions

Komatsu S wrote the manuscript and performed additional data analysis; Kido M and Kuramitsu K helped by supervising the manuscript; Tsugawa D, Gon H, Fukushima K, Urade T, Yanagimoto H, and Toyama H helped by performing data analysis; Fukumoto T supervised and approved the final manuscript.

Corresponding author

Correspondence to Shohei Komatsu.

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Komatsu, S., Kido, M., Kuramitsu, K. et al. Impact of Hepatectomy for Advanced Hepatocellular Carcinoma with Major Portal Vein Tumor Thrombus. J Gastrointest Surg 26, 822–830 (2022). https://doi.org/10.1007/s11605-021-05181-0

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