Surgical management of hepatocellular carcinoma patients with portal vein thrombosis: The United States Safety Net and Academic Center Collaborative Analysis

Background Although consensus guidelines generally discourage any surgical management (ASM; i.e., resection and/or transplantation) in patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT), recent series from Asia have challenged this paradigm. Methods Patients from the US Sa...

Full description

Saved in:
Bibliographic Details
Published in:Journal of surgical oncology 2021-02, Vol.123 (2), p.407-415
Main Authors: Ryon, Emily L., Kronenfeld, Joshua P., Lee, Rachel M., Yopp, Adam, Wang, Annie, Lee, Ann Y., Luu, Sommer, Hsu, Cary, Silberfein, Eric, Russell, Maria C., Goel, Neha, Merchant, Nipun B., Datta, Jashodeep
Format: Article
Language:English
Subjects:
cancer
Cancer surgery
Carcinoma, Hepatocellular - pathology
Carcinoma, Hepatocellular - surgery
Collaboration
Databases, Factual
Female
Follow-Up Studies
Hepatectomy - mortality
hepatobiliary
Humans
Liver cancer
Liver Neoplasms - pathology
Liver Neoplasms - surgery
Male
Middle Aged
outcomes
Portal Vein - physiopathology
Prognosis
Propensity Score
Retrospective Studies
Surgical outcomes
Survival Rate
Thrombosis
United States
Venous Thrombosis - physiopathology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background Although consensus guidelines generally discourage any surgical management (ASM; i.e., resection and/or transplantation) in patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT), recent series from Asia have challenged this paradigm. Methods Patients from the US Safety Net Collaborative database (2012–2014) with localized HCC and radiographically confirmed PVT were propensity‐score matched based on demographic and clinicopathologic factors associated with receipt of ASM and overall survival (OS). OS was compared between patients undergoing ASM and those not selected for surgery. Results Of 1910 HCC patients, 207 (14.5%) had localized disease and PVT. The majority received either liver‐directed therapies (LDTs; 34%) and/or targeted systemic therapies (36%). Twenty‐one patients (10.1%) underwent ASM (resection [n = 11], transplantation [n = 10]); a third experienced any complication with no 30‐day mortalities. Independent predictors of undergoing ASM were younger age, recent hepatology consultation, and lower model of end‐stage liver disease (MELD) score. After matching for age, comorbidities, MELD, tumor size, receipt of LDT, or systemic therapy, OS was significantly longer for patients selected for ASM versus non‐ASM patients (median not reached vs. 5.8 months, p 
ISSN:0022-4790
1096-9098
DOI:10.1002/jso.26282