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World Journal of Surgery

, Volume 16, Issue 6, pp 1172–1176 | Cite as

Liver resection for hepatocellular carcinoma (HCC) with direct removal of tumor thrombi in the main portal vein

  • Yoshio Yamaoka
  • Kaoru Kumada
  • Keiichi Ino
  • Takashi Takayasu
  • Yasuyuki Shimahara
  • Keiichiro Mori
  • Akira Tanaka
  • Taisuke Morimoto
  • Yoshiro Taki
  • Masanobu Washida
  • Dai Manaka
  • Michihiro Hayashi
  • Takusi Fujita
  • Kazue Ozawa
Original Scientific Reports

Abstract

Since the tumor thrombus in the main portal vein appears in the terminal stage of hepatocellular carcinoma (HCC), any attempt to remove it surgically is thought to be impractical as the malignancy itself cannot be entirely removed. During the past 5 years, we have performed tumor thrombectomy combined with hepatectomy in 29 of 298 patients with HCC. This combined therapy was initially decided upon as an emergency measure to prevent impending rupture of esophageal varices, rather than to improve patient survival. Since portal flow was obtained after removal of thrombi, this condition enabled transcatheter arterial embolization (TAE) and/or percutaneous ethanol injection therapy (PEIT). Although improved patient survival was not the primary goal of the emergency operation and there was an operative mortality of 11%, half of the other patients in the present series had unexpectedly high survival rates of 1 year (52.2%), 2 years (23.2%), and 3 years (11.6%), which were significantly higher than in patients not undergoing operation (n=22).

Keywords

Hepatocellular Carcinoma Liver Resection Esophageal Varix Tumor Thrombus Transcatheter Arterial Embolization 
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.

Résumé

Lorsqu'il existe un thrombus dans la veine porte au cours d'un carcinome hépatocellulaire (CHC), l'exérèse est généralement déconseillée car le plus souvent la tumeur n'est pas enlevable chirurgicalement. Au cours de ces 5 dernières années, nous avons effectué une thrombectomie associée à une hépatectomie dans 29 des 298 cas de CHC. Cette attitude thérapeutique était, à l'origine, destinée à prévenir la rupture imminente des varices oesophagiennes plutôt qu'à améliorer la survie. Une fois la circulation portale a été ré-établie, l'embolisation par cathéter artériel et/ou par injection percutanée d'éthanol a été possible. Alors que l'amélioration de survie n'était pas le but initial de ce geste thérapeutique, et que la mortalité périopératoire a été de 11%, près de la moitié des patients ayant survecu la période périopératoire ont eu une survie significativement plus longue que les patients non opérés (n=22): 52.2% à un an, 23.2% à deux ans et 11.6% à trois ans.

Resumen

Puesto que el trombo tumoral en la vena porta principal aparece en el estado terminal del carcinoma hepatocelular (CHC), cualquier esfuerzo destinado a removerlo por medios quirúrgicos se considera poco práctico teniendo en cuenta que la neoplasia no puede ser totalmente resecada. En el curso de los últimos 5 años hemos realizado la trombectomía tumoral combinada con hepatectomía en 29 de 298 casos de CHC. Esta modalidad de terapia combinada fue adoptada inicialmente como una medida de emergencia destinada a prevenir la ruptura de várices esofágicas, y no con miras a incrementar la sobrevida del paciente. El hecho de lograr flujo portal después de la remoción del trombo hace posible la embolización arterial por catéter y/o la inyección percutánea de etanol. Aunque el logro de una mayor tasa de sobrevida no constituyó el objetivo primario de la operación de emergencia y aunque se observó una mortalidad de 11%, la otra mitad de los pacientes en esta serie tuvo una inesperada mayor tasa de sobrevida a 1 año (52.2%), 2 años (23.2%) y 3 años (11.6%), cifras significativamente superiores a las del grupo de pacientes que no fueron operados (n=22).

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Copyright information

© the Société Internationale de Chirurgie 1992

Authors and Affiliations

  • Yoshio Yamaoka
    • 1
  • Kaoru Kumada
    • 1
  • Keiichi Ino
    • 1
  • Takashi Takayasu
    • 1
  • Yasuyuki Shimahara
    • 1
  • Keiichiro Mori
    • 1
  • Akira Tanaka
    • 1
  • Taisuke Morimoto
    • 1
  • Yoshiro Taki
    • 1
  • Masanobu Washida
    • 1
  • Dai Manaka
    • 1
  • Michihiro Hayashi
    • 1
  • Takusi Fujita
    • 1
  • Kazue Ozawa
    • 1
  1. 1.The Second Department of SurgeryKyoto University Faculty of MedicineKyotoJapan

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