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World Journal of Surgery

, Volume 38, Issue 2, pp 490–496 | Cite as

Surgical Outcomes in Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombosis

  • Kenneth S. H. Chok
  • Tan To Cheung
  • See Ching Chan
  • Ronnie T. P. Poon
  • Sheung Tat Fan
  • Chung Mau Lo
Article

Abstract

Background

Different approaches to surgical treatment of portal vein tumor thrombosis (PVTT) have been advocated. This study investigated the outcomes of different surgical approaches in hepatocellular carcinoma (HCC) patients with PVTT.

Methods

We reviewed prospectively collected data for all patients who underwent hepatectomy for HCC at our hospital between December 1989 and December 2010. Patients were excluded from analysis if they had extrahepatic disease, PVTT reaching the level of the superior mesenteric vein, or hepatectomy with a positive resection margin. The remaining patients were divided into three groups for comparison: group 1, with ipsilateral PVTT resected in a hepatectomy; group 2, with PVTT extending to or beyond the portal vein bifurcation, treated by en bloc resection followed by portal vein reconstruction; group 3, with PVTT extending to or beyond the portal vein bifurcation, treated by thrombectomy.

Results

A total of 88 patients, with a median age of 54 years, were included in the analysis. Group 2 patients were younger, with a median age of 43.5 years versus 57 in group 1 and 49 in group 3 (p = 0.017). Group 1 patients had higher preoperative serum alpha-fetoprotein levels, with a median of 8,493 ng/mL versus 63.25 in group 2 and 355 in group 3 (p = 0.004), and shorter operation time, with a median of 467.5 min versus 663.5 in group 2 and 753 in group 3 (p = 0.018). No patient had thrombus in the main portal vein. Two (2.8 %) hospital deaths occurred in group 1 and one (10 %) in group 2, but none in group 3 (p = 0.440). The rates of complication in groups 1, 2, and 3 were 31.9, 50.0, and 71.4 %, respectively (p = 0.079). The median overall survival durations were 10.91, 9.4, and 8.58 months, respectively (p = 0.962), and the median disease-free survival durations were 4.21, 3.78, and 1.51 months, respectively (p = 0.363). The groups also had similar patterns of disease recurrence (intrahepatic: 33.8 vs. 28.6 vs. 40.0 %; extrahepatic: 16.9 vs. 14.3 vs. 0 %; both: 28.2 vs. 42.9 vs. 40.0 %; no recurrence: 21.1 vs. 14.3 vs. 20.0 %; p = 0.836).

Conclusions

The three approaches have similar outcomes in terms of survival, complication, and recurrence. Effective adjuvant treatments need to be developed to counteract the high incidence of recurrence.

Keywords

Portal Vein Bloc Resection Future Liver Remnant Portal Vein Resection Portal Vein Tumor Thrombosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Hospital Authority (2009). Hong Kong Cancer Registry 2009. Hong Kong, China. http://www3.ha.org.hk/cancereg/. Accessed 2 Dec 2012
  2. 2.
    El-Serag HB, Mason AC (1999) Rising incidence of hepatocellular carcinoma in the United States. N Engl J Med 340:745–750PubMedCrossRefGoogle Scholar
  3. 3.
    Fan ST, Lo CM, Liu CL et al (1999) Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 229:322–330PubMedCrossRefGoogle Scholar
  4. 4.
    Colella G, Bottelli R, De Carlis L et al (1998) Hepatocellular carcinoma: comparison between liver transplantation, resective surgery, ethanol injection and chemoembolization. Transpl Int 11(Suppl 1):S193–S196PubMedGoogle Scholar
  5. 5.
    Fong Y, Sun RL, Jarnagin W et al (1999) An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 229:790–800PubMedCrossRefGoogle Scholar
  6. 6.
    Llovet JM, Bustamante J, Castells A et al (1999) Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 29:62–67PubMedCrossRefGoogle Scholar
  7. 7.
    Wu CC, Hsieh SR, Chen JT et al (2000) An appraisal of liver and portal vein resection for hepatocellular carcinoma with tumor thrombi extending to portal bifurcation. Arch Surg 135:1273–1279PubMedCrossRefGoogle Scholar
  8. 8.
    Yamaoka Y, Kumada K, Ino K et al (1992) Liver resection for hepatocellular carcinoma with direct removal of tumour thrombi in the main portal vein. World J Surg 16:1171–1176. doi: 10.1007/BF02067093 CrossRefGoogle Scholar
  9. 9.
    Tanaka A, Morimoto T, Yamaoka Y (1996) Implications of surgical treatment for advanced hepatocellular carcinoma with tumour thrombi in the portal vein. Hepatogastroenterology 43:637–643PubMedGoogle Scholar
  10. 10.
    Inoue Y, Hasegawa K, Ishizawa T et al (2009) Is there any difference in survival according to the portal tumour thrombectomy method in patients with hepatocellular carcinoma? Surgery 145:9–19PubMedCrossRefGoogle Scholar
  11. 11.
    Pugh RN, Murray-Lyon IM, Dawson JL et al (1973) Transection of the oesophagus for bleeding varices. Br J Surg 60:646–649PubMedCrossRefGoogle Scholar
  12. 12.
    Fan ST, Lai EC, Lo CM et al (1995) Hospital mortality of major hepatectomy for hepatocellular carcinoma associated with cirrhosis. Arch Surg 130:198–203PubMedCrossRefGoogle Scholar
  13. 13.
    Lau H, Man K, Fan ST et al (1997) Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy. Br J Surg 84:1255–1259PubMedCrossRefGoogle Scholar
  14. 14.
    Liu CL, Fan ST, Lo CM et al (2004) Abdominal drainage after hepatic resection is contraindicated in patients with chronic liver diseases. Ann Surg 239:194–201PubMedCrossRefGoogle Scholar
  15. 15.
    Couinaud C, Foi Le (1957) Etudes Anatomiques et Chirugicales. Masson Publishers, Paris, pp 400–409Google Scholar
  16. 16.
    Cheung TT, Chan SC, Ho CL et al (2011) Can positron emission tomography with the dual tracers (11 C)acetate and (18 F)fludeoxyglucose predict microvascular invasion in hepatocellular carcinoma? Liver Transpl 17:1218–1225PubMedCrossRefGoogle Scholar
  17. 17.
    Poon RT, Fan ST, Lo CM et al (1999) Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg 229:216–222PubMedCrossRefGoogle Scholar
  18. 18.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCrossRefGoogle Scholar
  19. 19.
    Kumada K, Ozawa K, Okamoto R et al (1990) Hepatic resection for advanced hepatocellular carcinoma with removal of portal vein tumour thrombi. Surgery 108:821–827PubMedGoogle Scholar
  20. 20.
    Ohkubo T, Yamamoto J, Sugawara Y et al (2000) Surgical results for hepatocellular carcinoma with macroscopic portal vein tumor thrombosis. J Am Coll Surg 191:657–660PubMedCrossRefGoogle Scholar
  21. 21.
    Konishi M, Ryu M, Kinoshita T et al (2001) Surgical treatment of hepatocellular carcinoma with direct removal of the tumor thrombus in the main portal vein. Hepatogastroenterology 48:1421–1424PubMedGoogle Scholar
  22. 22.
    Pawlik TM, Poon RT, Abdalla EK et al (2005) Hepatectomy for hepatocellular carcinoma with major portal or hepatic vein invasion: results of a multicenter study. Surgery 137:403–410PubMedCrossRefGoogle Scholar
  23. 23.
    Chen XP, Qiu FZ, Wu ZD et al (2006) Effects of location and extension of portal vein tumor thrombus on long-term outcomes of surgical treatment for hepatocellular carcinoma. Ann Surg Oncol 13:940–946PubMedCrossRefGoogle Scholar
  24. 24.
    Ikai I, Hatano E, Hasegawa S et al (2006) Prognostic index for patients with hepatocellular carcinoma combined with tumor thrombosis in the major portal vein. J Am Coll Surg 202:431–438PubMedCrossRefGoogle Scholar
  25. 25.
    Le Treut YP, Hardwigsen J, Ananian P et al (2006) Resection of hepatocellular carcinoma with tumor thrombus in the major vasculature: a European case-control series. J Gastrointest Surg 10:855–862PubMedCrossRefGoogle Scholar
  26. 26.
    Chan SC, Liu CL, Lo CM et al (2003) Value of live donor liver transplantation experience in major hepatectomy for hepatocellular carcinoma. Arch Surg 138:265–271PubMedCrossRefGoogle Scholar
  27. 27.
    Li Q, Wang J, Sun Y et al (2006) 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 30:2004–2011. doi: 10.1007/s00268-006-0271-6 PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Kenneth S. H. Chok
    • 1
  • Tan To Cheung
    • 1
  • See Ching Chan
    • 1
  • Ronnie T. P. Poon
    • 1
  • Sheung Tat Fan
    • 1
  • Chung Mau Lo
    • 1
  1. 1.Department of SurgeryThe University of Hong KongHong KongChina

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