Surgical outcomes of hepatocellular carcinoma invading hepatocaval conlfuence

BACKGROUND: Combined liver and inferior vena cava (IVC) resection followed by IVC and/or hepatic vein reconstruc-tion (HVR) is a curative operation for selected patients with hepatocellular carcinoma (HCC) invading the hepatocaval conlfuence. The present study aimed to elucidate the prog-nostic factors for patients with HCC invading the hepatocaval conlfuence.
METHODS: Forty-two consecutive patients underwent hepa-tectomy, combined with IVC replacement and/or HVR for HCC between January 2009 and December 2014 were included in this study. The cases were divided into three groups based on the surgical approaches of HVR: group 1 (n=13), tumor in-vaded the hepatocaval conlfuence but with one or two hepatic veins intact in the residual liver, thus only the replacement of IVC, not HVR; group 2 (n=23), the hepatic vein of the residual liver was also partially invaded, and the hepatic vein defect was repaired with patches locally; group 3 (n=6), three hepatic veins at the hepatocaval conlfuence were inifltrated, and the hepatic vein remnant was re-implanted onto the side of the tube graft. The patient characteristics, intra- and postopera-tive results, and long-term overall survival were compared among the three groups. The survival-related factors were analyzed by univariate and multivariate analysis.
RESULTS: The group 1 had higher preoperative alpha-fetopro-tein level (P<0.001), shorter operation time, hepatic ischemic time and hospital stay compared with groups 2 and 3 (P<0.05). The 1-, 3-, and 4-year overall survival rates of group 1 were 84.6%, 23.1% and 23.1%, respectively; group 2 were 78.3%, 8.7% and 8.7% respectively and group 3 were 83.3%, 0 and 0, respectively. The multivariate analysis showed that the inde-pendent poor prognostic factors of overall survival were pre-operative higher HBV DNA level (≥103 copies/mL;P=0.001), tumor size (≥9 cm;P<0.0001), age (≥60 years;P=0.010) and underwent HVR (P<0.0001).
CONCLUSIONS: Patients with reconstructing hepatic vein with patches locally (group 2) or to the artiifcial graft (group 3) had worse long-term survival than those without HVR (group 1). HVR was one of the unfavorable prognostic factors of overall survival.