Liver resection with thrombectomy as a treatment of hepatocellular carcinoma with major vascular invasion: results from a retrospective multicentric study

• Published in: The American journal of surgery 2015-07, Vol.210 (1), p.35-44
• Main Authors: Pesi, Benedetta, M.D, Ferrero, Alessandro, M.D, Grazi, Gianluca L., M.D, Cescon, Matteo, M.D, Russolillo, Nadia, M.D, Leo, Francesca, M.D, Boni, Luca, M.D, Pinna, Antonio D., M.D, Capussotti, Lorenzo, M.D, Batignani, Giacomo, M.D
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - secondary; Carcinoma, Hepatocellular - surgery; Catheters; Disease-Free Survival; Hepatectomy; Hepatocellular carcinoma; Humans; Liver cancer; Liver cirrhosis; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver resection; Macroscopic vascular thrombosis; Major vascular invasion; Middle Aged; Multicentric study; Neoplasm Invasiveness; Neoplastic Cells, Circulating; Retrospective Studies; Surgery; Survival Rate; Thrombectomy; Veins & arteries; Young Adult
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2014.09.041

Abstract Background The role of liver resection (LR) of hepatocellular carcinoma with macroscopic vascular thrombosis (MVT) remains controversial. The aim of this study is to evaluate whether the presence of MVT should still be considered a contraindication for LR. Methods Retrospective study was carried out on 62 patients who underwent LR and thrombectomy for hepatocellular carcinoma complicated by MVT. Of the 62 patients, 15 (36.5%) had tumor thrombus (TT) in the peripheral portal vein (Vp1), 5 (12.2%) in second branch (Vp2), and 21 (51.3%) in the first branch/portal vein trunk (Vp3), while on the hepatic/cava vein side, 8 (12.9%) had TT in the main trunk of the hepatic veins (Vv2) and 3 (4.8%) had TT reaching the vena cava/right atrium (Vv3). Results Perioperative major morbidity was 14.5%, while in-hospital mortality was 4.8%. Overall, 1, 3, and 5-year survival rates were 53.3%, 30.1%, and 20%, and disease-free survival rates were 31.7%, 20.8%, and 15.6%, respectively. There were no differences in survival about the MVT localized in Vp1, Vp2, or Vp3 ( P = .77), while we found a statistical trend between patients with Vv2 and Vv3 ( P  = .06). Conclusion Surgical resection seems to be justified in these patients, and the presence of MVT should no longer be considered an absolute contraindication for LR.