Resection of hepatocellular carcinoma with tumor thrombus in the major vasculature. A European case-control series |
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Authors: | Y Patrice Le Treut MD Jean Hardwigsen MD Pascal Ananian MD Jean Saïsse MD Emilie Grégoire MD Hubert Richa MD Pierre Campan MD |
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Institution: | 1. From the Department of Surgery and Liver Transplantation, H?pital de la Conception, 147 Boulevard Baille, 13385, Marseille Cedex 5, France
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Abstract: | Tumor thrombus in major vasculature is a frequent finding with a poor long-term prognosis in patients with hepatocellular
carcinoma (HCC). The utility of surgical resection is still controversial. This study compared morbidity and survival after
resection for HCC with and without tumor thrombus. Data of 108 patients who underwent major hepatic resection for HCC were
prospectively recorded. Patients were divided into two groups. The venous thrombectomy (VT) group included 26 patients who
had HCC with tumor thrombus in the portal or hepatic veins. The matched control group included 82 patients who had HCC without
tumor thrombus. Surgical technique, early outcome, and late survival were analyzed in each group. Multivariate analysis was
performed to assess the prognostic value of this feature. Surgical technique was comparable in the VT and control group with
regard to extent of hepatectomy, procedure duration, and transfusion requirements. Early postoperative outcome was also comparable.
Actuarial survival at 1, 3, and 5 years was 38%, 20%, and 13%, respectively, in the VT group (median: 9 months) versus 74%,
56%, and 33%, respectively, in the control group (median: 41 months). In the subgroup of patients with tumor thrombus limited
to the portal vein, actuarial survival at 1, 3, and 5 years was 50%, 26%, and 17%, respectively, (median: 12 months) and two
patients lived longer than 5 years. Multivariate analysis showed that incomplete resection, alphafetoprotein level greater
than 100 N, more than two tumor nodules, and tumor thrombus in major vasculature were independent factors of poor prognosis.
Survival after resection for HCC with tumor thrombus in the major vasculature is poorer than after resection for HCC without
tumor thrombus. However, an aggressive surgical strategy can provide significant survival with comparable morbidity in selected
cases, that is, tumor thrombus located in the portal vein only and expected complete resection of the lesions. |
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Keywords: | Hepatocellular carcinoma tumor thrombus venous invasion surgical resection |
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