Is there any difference in survival according to the portal tumor thrombectomy method in patients with hepatocellular carcinoma?

• Published in: Surgery 2009, Vol.145 (1), p.9-19
• Main Authors: Inoue, Yosuke, MD, Hasegawa, Kiyoshi, MD, PhD, Ishizawa, Takeaki, MD, Aoki, Taku, MD, PhD, Sano, Keiji, MD, PhD, Beck, Yoshifumi, MD, PhD, Imamura, Hiroshi, MD, PhD, Sugawara, Yasuhiko, MD, PhD, Kokudo, Norihiro, MD, PhD, Makuuchi, Masatoshi, MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Cohort Studies; Dissection; Female; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Hepatectomy; Humans; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; Neoplasm Invasiveness; Portal Vein; Retrospective Studies; Surgery; Survival Rate; Thrombectomy - methods; Treatment Outcome; Tumors; Venous Thrombosis - etiology; Venous Thrombosis - pathology; Venous Thrombosis - surgery
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2008.09.005

Background Although portal venous tumor thrombus (PVTT) is regarded as an ominous prognostic factor in patients with hepatocellular carcinoma (HCC), the optimal treatment method for maximizing both safety and long-term outcome has not yet been discussed. We describe a surgical technique in which the venous wall is peeled off from the PVTT. Methods In the peeling off (PO) technique, the portal venotomy was placed after adequate vascular control of portal flow. The PVTT was dissected from the portal venous wall and removed through the opening. Macroscopically residual PVTTs intruding into tiny branches were meticulously extracted. This procedure was compared with the en bloc resection of PVTT. Between 1995 and 2006, 49 patients underwent curative hepatic resections for HCC with macroscopic PVTT; these patients were classified according to whether the PO technique ( n = 20) or the en bloc technique ( n = 29) had been utilized. Both the short- and long-term results were compared between the 2 groups. Results No mortalities occurred in either group. Both the 5-year overall survival and the recurrence-free survival rates of the PO group were comparable with those of the en bloc group (39% vs 41% [ P = .90] and 23% vs 18% [ P = .89], respectively). No local recurrences or regrowth of the PVTT occurred in either group. Conclusion Our procedure is useful for removing PVTT extending beyond the bifurcation or into other sectors that should be preserved in terms of liver function and enables a more conservative resection than an en bloc technique without sacrificing curability.