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J Gastrointest Surg. 2009 Nov;13(11):1921-8. doi: 10.1007/s11605-009-0998-0. Epub 2009 Sep 2.

Efficacy of a hepatectomy and a tumor thrombectomy for hepatocellular carcinoma with tumor thrombus extending to the main portal vein.

Author information

1
Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Central Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, Japan.

Abstract

INTRODUCTION:

Hepatocellular carcinoma (HCC) with major portal tumor thrombus has been considered to be a fatal disease. A thrombectomy remains the only therapeutic option that offer a chance of complete tumor removal avoiding acute portal vein obstruction. However, the efficacy of tumor thrombectomy in addition to hepatectomy has not been well evaluated.

METHODS:

Of 979 patients who consecutively underwent initial HCC resection, 45 (4.6%) HCC patients with tumor invasion of the first branch of the portal vein (vp3) and tumor in the main portal trunk or the opposite-side portal branch (vp4) were retrospectively analyzed to evaluate the efficacy of hepatectomy and tumor thrombectomy.

RESULTS:

Alpha-fetoprotein, serosal invasion, and intrahepatic metastases were independently significant prognostic factors in all the 45 patients with vp3 or vp4 HCC. The 3- and 5-year survival rates in vp3 and vp4 group were 35.3% and 41.8%, and 21.2% and 20.9%, respectively. There were longer operative times and more intraoperative bleeding in patients with vp4, but no significant difference in mortality, morbidity, and survival between patients with vp3 and vp4.

CONCLUSION:

Hepatectomy and thrombectomy for vp4 could not only avoid acute portal occlusion due to tumor thrombus but provide a comparable survival benefit with hepatectomy for vp3.

PMID:
19727969
DOI:
10.1007/s11605-009-0998-0
[Indexed for MEDLINE]

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