Skip to main content
Log in

Effects of Location and Extension of Portal Vein Tumor Thrombus on Long-Term Outcomes of Surgical Treatment for Hepatocellular Carcinoma

  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The role of surgical resection and thrombectomy for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) is controversial. This study aimed to evaluate the effects of the location and extent of PVTT on the long-term outcomes of surgical treatment for HCC.

Methods

A total of 438 patients with HCC and PVTT underwent liver resection with or without thrombectomy. These 438 patients were divided into 2 groups: in group A, PVTT was located in the hepatic resection area or protruded into the first branch of the main portal vein beyond the resection line for <1 cm (286 patients), and in group B, PVTT extended into the main portal vein (152 patients). Concomitant thrombectomy was performed in 147 patients (51.4%) of group A and in all patients of group B.

Results

PVTT recurrence within 6 months after surgery in group B was significantly higher than that in group A: 76.9% vs. 11.3%. Remnant liver recurrence within 1 year after surgery was 45.0% in group A and 78.8% in group B. The cumulative 1-, 2-, 3-, and 5-year overall survival rates were 58.7%, 39.9%, 22.7%, and 18.1% for group A and 39.5%, 20.4%, 5.7%, and 0% for group B, respectively. The overall survivals were significantly better in group A than group B (P < .02).

Conclusions

Liver resection with thrombectomy yielded better outcomes in the HCC patients with PVTT confined to the first or second branch of the main portal vein compared with PVTT extending into the main portal vein.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Lau WY, Ho S, Leung TW, et al. Selective internal radiation therapy for non-resectable hepatocellular carcinoma with intraarterial infusion of yttrium-90 microspheres. Int J Radiat Oncol Biol Phys 1998; 40:583–92

    Article  PubMed  CAS  Google Scholar 

  2. Chen XP, Wu ZD, Qiu FZ. The history, present and prospect of the surgical treatment of primary liver cancer in China. Chin J Bases Clin Gen Surg 2000; 7:257–8.

    Google Scholar 

  3. Wu MC. Clinical and experimental research of primary liver cancer in China. Chinese-German J Clin Oncol 2002; 1:1–4

    Article  Google Scholar 

  4. Nakashima T, Okuda K, Kojiro M, Jimi A, Yamaguchi R, Sakamoto K. Pathology of hepatocellular carcinoma in Japan. 232 consecutive cases autopsied in the years. Cancer 1983; 51:863–77.

    PubMed  CAS  Google Scholar 

  5. Chen XP, Qiu FZ, Wu ZD, Zhang BX. Chinese experience with hepatectomy for huge hepatocellular carcinoma. Br J Surg 2004; 91:322–6

    Article  PubMed  CAS  Google Scholar 

  6. Nagasue N, Uchida M, Makino Y, et al. Incidence and factors associated with intrahepatic recurrence following resection of hepatocellular carcinoma. Gastroenterology 1993; 105:488–94

    PubMed  CAS  Google Scholar 

  7. Shiina S, Tagawa K, Unuma T, Terano A. Percutaneous ethanol injection therapy for treatment of hepatocellular carcinoma. AJR Am J Roentgenol 1990; 154:947–51

    PubMed  CAS  Google Scholar 

  8. Bismuth H, Chiche L, Adam R, Castaing D, Diamond T, Dennison A. Liver transplantation versus resection for hepatocellular carcinoma in cirrhosis. Ann Surg 1990; 211:277–87

    Google Scholar 

  9. Okuda K, Musha H, Yoshida T, Kanda Y, Yamazaki T. Angiographic demonstration of intrahepatic arterio-portal anastomoses in hepatocellular carcinoma. Radiology 1977; 122:53–8

    PubMed  CAS  Google Scholar 

  10. Livraghi T, Grigioni W, Mazziotti A, Sangalli G, Vettori C. Percutaneous ethanol injection of portal thrombosis in hepatocellular carcinoma: a new possible treatment. Tumori 1990; 76:394–7

    PubMed  CAS  Google Scholar 

  11. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinoma in patients with cirrhosis. N Engl J Med 1996; 334:693–9

    Article  PubMed  CAS  Google Scholar 

  12. Cillo U, Vitale A, Bassanello M, et al. Liver transplantation for the treatment of moderately or well-differentiated hepatocellular carcinoma. Ann Surg 2004; 239:150–9

    Article  PubMed  Google Scholar 

  13. Gondolesi GE, Roayaie S, Munoz L, et al. Adult living donor liver transplantation for patients with hepatocellular carcinoma: extending UNOS priority criteria. Ann Surg 2004; 239:2004.

    Google Scholar 

  14. Shimada M, Takenaka K, Gion T, et al. Progress of recurrent hepatocellular carcinoma: a 10-year surgical experience in Japan. Gastroenterology 1996; 111:720–6

    Article  PubMed  CAS  Google Scholar 

  15. Yamada R, Sato M, Kawabata M, et al. Hepatic artery embolization in 120 patients with unresectable hepatoma. Radiology 1983; 148:397–401

    PubMed  CAS  Google Scholar 

  16. Okazai M, Higashihara H, Shinjo H. Chemoembolization. In: Livraghi T, Mukuuchi M, Burscarini L, eds. Diagnosis and Treatment of Hepatocellular Carcinoma. London: Greenwich Medical Media, 1997; 307–26

    Google Scholar 

  17. Lee HS, Kim JS, Choi IJ, Chung JW, Park JH, Kim CY. The safety and efficacy of transcatheter arterial chemoembolization in the treatment of patients with hepatocellular carcinoma and main portal obstruction. A prospective controlled study. Cancer 1997; 79:2087–93

    Article  PubMed  CAS  Google Scholar 

  18. Poon RT, Fan ST, Lo CM, Liu CL, Wong J. Intrahepatic recurrence after curative resection of hepatocellular carcinoma: long-term results of treatment and prognostic factors. Ann Surg 1999; 229:216–22

    Article  PubMed  CAS  Google Scholar 

  19. Llovet JM, Bustamante J, Castells A, et al. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 1999; 29:62–7

    Article  PubMed  CAS  Google Scholar 

  20. Yamanaka N, Okamoto E, Toyosaka A, et al. Prognostic factors after hepatectomy for hepatocellular carcinomas. A univariate and multivariate analysis. Cancer 1990; 65:1104–10

    PubMed  CAS  Google Scholar 

  21. Shimada M, Takenaka K, Kawahara N, et al. Surgical treatment strategy for patients with stage IV hepatocellular carcinoma. Surgery 1996; 119:517–22

    Article  PubMed  CAS  Google Scholar 

  22. Fuster J, Garcia-Valdecasas JC, Grande L, et al. Hepatocellular carcinoma and cirrhosis. Results of surgical treatment in a European series. Ann Surg 1996; 223:297–302

    Article  PubMed  CAS  Google Scholar 

  23. Fong Y, Sun RL, Jarnagin W, Blumgart LH. An analysis of 412 cases of hepatocellular carcinoma at a Western center. Ann Surg 1999; 229:790–800

    Article  PubMed  CAS  Google Scholar 

  24. Ikai I, Yamaoka Y, Yamamoto Y, et al. Surgical intervention for patients with stage IV-A hepatocellular carcinoma without lymph node metastasis: proposal as a standard therapy. Ann Surg 1998; 227:433–9

    Article  PubMed  CAS  Google Scholar 

  25. Izumi R, Shimizu K, Ii T, et al. Prognostic factors of hepatocellular carcinoma in patients undergoing hepatic resection. Gastroenterology 1994; 106:720–7

    PubMed  CAS  Google Scholar 

  26. Liver Cancer Study Group of Japan. Classification of Primary Liver Cancer. 1st English ed. Tokyo: Kanehara & Co, 1997

    Google Scholar 

  27. Lee PH, Lin WJ, Tsang YM, et al. Clinical management of recurrent hepatocellular carcinoma. Ann Surg 1995; 222:670–6

    PubMed  CAS  Google Scholar 

  28. Asahara T, Itamoto T, Katayama K, et al. Hepatic resection with tumor thrombectomy for hepatocellular carcinoma with tumor thrombi in the major vasculatures. Hepatogastroenterology 1999; 46:1862–9

    PubMed  CAS  Google Scholar 

  29. Tanaka A, Morimoto T, Yamaoka Y. Implications of surgical treatment for advanced hepatocellular carcinoma with tumor thrombi in the portal vein. Hepatogastroenterology 1996; 43:637–43

    PubMed  CAS  Google Scholar 

  30. Yamaoka Y, Kumada K, Ino K, et al. Liver resection for hepatocellular carcinoma (HCC) with direct removal of tumor thrombi in the main portal vein. World J Surg 1992; 16:1172–6

    Article  PubMed  CAS  Google Scholar 

  31. Kumada K, Ozawa K, Okamoto R, et al. Hepatic resection for advanced hepatocellular carcinoma with removal of portal vein tumor thrombi. Surgery 1990; 108:821–7

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Professor W. Y. Lau, Department of Surgery, Chinese University of Hong Kong, for reading the manuscript and providing valuable advice. Supported by grant 321 (2001) from the Chinese Ministry of Public Health for the Key Clinical Projects.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Xiao-Ping Chen MD, PhD, FACS.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chen, XP., Qiu, FZ., Wu, ZD. et al. Effects of Location and Extension of Portal Vein Tumor Thrombus on Long-Term Outcomes of Surgical Treatment for Hepatocellular Carcinoma. Ann Surg Oncol 13, 940–946 (2006). https://doi.org/10.1245/ASO.2006.08.007

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/ASO.2006.08.007

Keywords

Navigation