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Annals of Surgical Oncology

, Volume 20, Issue 3, pp 914–922 | Cite as

Survival Benefit of Surgical Treatment for Hepatocellular Carcinoma with Inferior Vena Cava/Right Atrium Tumor Thrombus: Results of a Retrospective Cohort Study

  • Yi Wang
  • Lei Yuan
  • Rui-liang Ge
  • Yanfu Sun
  • Gongtian Wei
Hepatobiliary Tumors

Abstract

Background

The significance of surgery in the treatment of hepatocellular carcinoma (HCC) extending into the inferior vena cava (IVC)/right atrium (RA) is currently unclear. We sought to clarify whether surgical treatment can improve survival in such patients.

Methods

A retrospective review was undertaken of patients with HCC and IVC/RA tumor thrombus who were potential candidates for surgery but who were finally treated surgically and nonsurgically between September 2000 and October 2010. The patients were subdivided according to therapeutic modalities, and the results for each group were compared.

Results

A total of 56 patients were included in this study. They were divided into three groups. Twenty-five patients underwent hepatectomy plus thrombectomy (surgical group), with minor morbidity and no mortality; the patients in this group had 1-, 3-, and 5-year survival rates of 68.0, 22.5, and 13.5 %, respectively, with a median survival of 19 months. Twenty patients were treated with transcatheter arterial chemoembolization, with 1- and 3-year survival rates of 15.0 and 5.0 %, respectively (median survival 4.5 months). Eleven patients received symptomatic treatment only, and no one in this group survived longer than 1 year (median survival 5 months). The patients in surgical group survived significantly longer than the patients in the other two groups (p < 0.001).

Conclusions

Although technically challenging, surgery for HCC with IVC/RA tumor thrombus can be safely performed and should be considered in patients with resectable primary tumor and sufficient hepatic reservoir because compared with transcatheter arterial chemoembolization or symptomatic treatment, it significantly improved patient survival.

Keywords

Inferior Vena Cava Tace Hepatic Vein Median Survival Time Tumor Thrombus 
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

Acknowledgment

The authors thank Lin Han (Department of Cardiothoracic Surgery, Changhai Hospital) for his technique support in extraction of the tumor thrombus from the RA.

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Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Yi Wang
    • 1
  • Lei Yuan
    • 1
  • Rui-liang Ge
    • 1
  • Yanfu Sun
    • 1
  • Gongtian Wei
    • 1
  1. 1.The Second Department of Hepatic SurgeryEastern Hepatobiliary Surgery HospitalShanghaiChina

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