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Surgical Strategy for Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus Based on Prognostic Factors

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Rationale

Surgical strategy for patients with hepatocellular carcinoma and portal vein tumor thrombus (PVTT) remains to be established.

Methods

From 1990 to 2008, 48 hepatocellular carcinoma patients with PVTT detected by preoperative imaging underwent hepatic resection, and their clinical data were retrospectively analyzed. Possible prognostic factors for survival were analyzed with postoperative survival curves, and significant factors were determined by univariate and multivariate analysis. The frequency of postoperative severe complications was investigated for each prognostic factor.

Results

Significant prognostic factors included patient age <60 years, serum total bilirubin (T-Bil) >0.8 mg/dl, serum aspartate aminotransferase >30 IU/L, serum alkaline phosphatase (ALP) >300 IU/L, tumor size >4 cm, PVTT in the main trunk (Vp4), and a surgical margin <1 mm by univariate analysis, and independent prognostic factors were serum T-Bil, ALP, and Vp4. No patient with Vp4 survived for more than 400 days after surgery, and frequency of postoperative severe complications in these Vp4 patients was significantly higher than in other Vp1–3 patients.

Conclusion

Hepatic resection as a first-choice treatment should be carefully selected in patients with Vp4 unless emergent removal of the PVTT is required.

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Authors and Affiliations

  1. Department of Surgical Oncology and Regulation of Organ Function, Miyazaki University School of Medicine, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan

    Kazuhiro Kondo, Kazuo Chijiiwa, Masahiro Kai, Kazuhiro Otani, Koki Nagaike, Jiro Ohuchida, Masahide Hiyoshi & Motoaki Nagano

Authors
  1. Kazuhiro Kondo
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  2. Kazuo Chijiiwa
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  3. Masahiro Kai
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  4. Kazuhiro Otani
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  5. Koki Nagaike
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  6. Jiro Ohuchida
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  7. Masahide Hiyoshi
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  8. Motoaki Nagano
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Correspondence to Kazuo Chijiiwa.

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Kondo, K., Chijiiwa, K., Kai, M. et al. Surgical Strategy for Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus Based on Prognostic Factors. J Gastrointest Surg 13, 1078–1083 (2009). https://doi.org/10.1007/s11605-009-0854-2

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  • DOI: https://doi.org/10.1007/s11605-009-0854-2

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