Skip to main content
SpringerLink
Log in

Surgical Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus

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

Abstract

Background

The role of liver resection in patients with hepatocellular carcinoma (HCC) accompanying with portal vein tumor thrombus (PVTT) remains controversial. This article aimed to evaluate the significance of different location and extent of PVTT on surgical outcomes after liver resection for HCC.

Materials and Methods

A retrospective study was carried out on patients who underwent partial hepatectomy with or without portal thrombectomy for HCC with PVTT in a single tertiary center from January 2001 to December 2003. According to the extent, PVTT was divided into 4 types (I-segmental/sectoral branches of portal vein, II-left and/or right portal vein, III-main portal vein trunk, and IV-superior mesenteric vein).

Results

A total of 406 patients with HCC and PVTT who underwent partial hepatectomy were studied. The complication rate and hospital mortality rate were 32.8 and 0.2%, respectively. After a median follow-up of 6.4 months, 128 patients (31.5%) died. The 1- and 3-year overall survival rates were 34.4 and 13.0%, respectively. The 1- and 3-year disease-free survival rates were 13.3 and 4.7%, respectively. Patients with PVTT located in the segmental, sectoral, or right and/or left portal veins (types I and II) showed significantly better survival than those with PVTT extended to the main trunk of the portal vein or the superior mesenteric vein (types III and IV).

Conclusions

Liver resection is justified in selected patients with PVTT located in the segmental or sectoral branches of the portal vein. However, surgical resection for PVTT involving the portal bifurcation or the main trunk is still controversial.

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

Access this article

Log in via an institution

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. Primary hepatocellular carcinoma. In: Blumgart LH, Fong Y, eds., Surgery of the Liver and Biliary Tract Volume II. 3rd ed. London: W.B. Saunders, 2000;1423–50.

    Google Scholar 

  2. Lau WY. Management of hepatocellular carcinoma. J R Coll Surg Edinb. 2002;47:389–99.

    CAS  PubMed  Google Scholar 

  3. Lai EC, Lau WY. The continuing challenge of hepatic cancer in Asia. Surgeon. 2005;3:210–5.

    Article  CAS  PubMed  Google Scholar 

  4. Lau WY, Lai EC, Yu SC. Management of portal vein tumor thrombus. In: Lau WY. Hepatocellular Carcinoma. Singapore: World Scientific Publishing Co. Pte. Ltd. 2008;739–60.

    Chapter  Google Scholar 

  5. Cheng SQ, Wu MC, Chen H, Shen F, Yang JH, Ding GH, et al. Tumor thrombus types influence the prognosis of hepatocellular carcinoma with the tumor thrombi in the portal vein. Hepatogastroenterology. 2007;54:499–502.

    Google Scholar 

  6. Ohkubo T, Yamamoto J, Sugawara Y, Shimada K, Yamasaki S, Makuuchi M, et al. Surgical results for hepatocellular carcinoma with macroscopic portal vein tumor thrombosis. J Am Coll Surg. 2000;191:657–60.

    Article  CAS  PubMed  Google Scholar 

  7. Wu CC, Hsieh SR, Chen JT, Ho WL, Lin MC, Yeh DC, et al. An appraisal of liver and portal vein resection for hepatocellular carcinoma with tumor thrombi extending to portal bifurcation. Arch Surg. 2000;135:1273–9.

    Article  CAS  PubMed  Google Scholar 

  8. Konishi M, Ryu M, Kinoshita T, Inoue K. Surgical treatment of hepatocellular carcinoma with direct removal of the tumor thrombus in the main portal vein. Hepatogastroenterology. 2001;48:1421–4.

    CAS  PubMed  Google Scholar 

  9. Pawlik TM, Poon RT, Abdalla EK, Ikai I, Nagorney DM, Belghiti J, et al. Hepatectomy for hepatocellular carcinoma with major portal or hepatic vein invasion: results of a multicenter study. Surgery. 2005;137:403–10.

    Article  PubMed  Google Scholar 

  10. Chen XP, Qiu FZ, Wu ZD, Zhang ZW, Huang ZY, Chen YF, 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. 2006;13:940–6.

    Article  PubMed  Google Scholar 

  11. Ikai I, Hatano E, Hasegawa S, Fujii H, Taura K, Uyama N, et al. Prognostic index for patients with hepatocellular carcinoma combined with tumor thrombosis in the major portal vein. J Am Coll Surg. 2006;202:431–8.

    Article  PubMed  Google Scholar 

  12. Le Treut YP, Hardwigsen J, Ananian P, Saisse J, Gregoire E, Richa H, et al. Resection of hepatocellular carcinoma with tumor thrombus in the major vasculature. A European case-control series. J Gastrointest Surg. 2006;10:855–62.

    Article  PubMed  Google Scholar 

  13. Fujii T, Takayasu K, Muramatsu Y, Moriyama N, Wakao F, Kosuge T, et al. Hepatocellular carcinoma with portal tumor thrombus: analysis of factors determining prognosis. Jpn J Clin Oncol. 1993;23:105–9.

    CAS  PubMed  Google Scholar 

  14. Kondo K, Chijiiwa K, Kai M, Otani K, Nagaike K, Ohuchida J, et al. Surgical strategy for hepatocellular carcinoma patients with portal vein tumor thrombus based on prognostic factors. J Gastrointest Surg. 2009;13:1078–83.

    Article  PubMed  Google Scholar 

  15. Adachi E, Maeda T, Kajiyama K, Kinukawa N, Matsumata T, Sugimachi K, et al. Factors correlated with portal venous invasion by hepatocellular carcinoma: univariate and multivariate analyses of 232 resected cases without preoperative treatments. Cancer. 1996;77:2022–31.

    Article  CAS  PubMed  Google Scholar 

  16. Zhou J, Tang ZY, Wu ZQ, Zhou XD, Ma ZC, Tan CJ, et al. Factors influencing survival in hepatocellular carcinoma patients with macroscopic portal vein tumor thrombosis after surgery, with special reference to time dependency: a single-center experience of 381 cases. Hepatogastroenterology. 2006;53:275–80.

    PubMed  Google Scholar 

  17. Sakata H, Konishi M, Ryu M, Kinoshita T, Satake M, Moriyama N, et al. Prognostic factors for hepatocellular carcinoma presenting with macroscopic portal vein tumor thrombus. Hepatogastroenterology. 2004;51:1575–80.

    PubMed  Google Scholar 

  18. Li Q, Wang J, Sun Y, Cui YL, Juzi JT, Li HX, et al. Efficacy of postoperative transarterial chemoembolization and portal vein chemotherapy for patients with hepatocellular carcinoma complicated by portal vein tumor thrombosis—a randomized study. World J Surg. 2006;30:2004–11.

    Article  CAS  PubMed  Google Scholar 

  19. Minagawa M, Makuuchi M, Takayama T, Ohtomo K. Selection criteria for hepatectomy in patients with hepatocellular carcinoma and portal vein tumor thrombus. Ann Surg. 2001;233:379–84.

    Article  CAS  PubMed  Google Scholar 

  20. Niguma T, Mimura T, Tutui N. Adjuvant arterial infusion chemotherapy after resection of hepatocellular carcinoma with portal thrombosis: a pilot study. J Hepatobiliary Pancreat Surg. 2005;12:249–53.

    Article  PubMed  Google Scholar 

  21. Fan J, Zhou J, Wu ZQ, Qiu SJ, Wang XY, Shi YH, et al. Efficacy of different treatment strategies for hepatocellular carcinoma with portal vein tumor thrombosis. World J Gastroenterol. 2005;11:1215–9.

    PubMed  Google Scholar 

  22. 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.

    CAS  PubMed  Google Scholar 

  23. Minagawa M, Makuuchi M. Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus. World J Gastroenterol. 2006;12:7561–7.

    CAS  PubMed  Google Scholar 

  24. Lau WY, Lai EC. Salvage surgery following downstaging of unresectable hepatocellular carcinoma—a strategy to increase resectability. Ann Surg Oncol. 2007;14:3301–9.

    Article  PubMed  Google Scholar 

  25. Lau WY, Lai EC The current role of radiofrequency ablation in the management of hepatocellular carcinoma: a systematic review. Ann Surg. 2009;249:20–5.

    Article  PubMed  Google Scholar 

  26. Lau WY, Yu SC, Lai EC, Leung TW. Transarterial chemoembolization for hepatocellular carcinoma. J Am Coll Surg. 2006;202:155–68.

    Article  CAS  PubMed  Google Scholar 

  27. Lau WY, Ho SK, Yu SC, Lai EC, Liew CT, Leung TW. Salvage surgery following downstaging of unresectable hepatocellular carcinoma. Ann Surg. 2004;240:299–305.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

Supported by the grants of National Natural Science Foundation (30873352), Shanghai Science and Technology Committee (Project No: 07JC 14066) and Shanghai Education Committee of Shuguang Plan (05SG39).

Author information

Authors and Affiliations

  1. Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai, China

    Jie Shi MD, Eric C. H. Lai MBChB, MRCS(Ed), FRACS, Nan Li MD, Wei-Xing Guo MD, Jie Xue MD, Wan Yee Lau MD, FRCS, FACS, FRACS(Hon), Meng-Chao Wu MD & Shu-Qun Cheng MD

  2. Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China

    Eric C. H. Lai MBChB, MRCS(Ed), FRACS & Wan Yee Lau MD, FRCS, FACS, FRACS(Hon)

Authors
  1. Jie Shi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eric C. H. Lai MBChB, MRCS(Ed), FRACS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nan Li MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wei-Xing Guo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jie Xue MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wan Yee Lau MD, FRCS, FACS, FRACS(Hon)
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Meng-Chao Wu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shu-Qun Cheng MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shu-Qun Cheng MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shi, J., Lai, E.C.H., Li, N. et al. Surgical Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus. Ann Surg Oncol 17, 2073–2080 (2010). https://doi.org/10.1245/s10434-010-0940-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-010-0940-4

Keywords

Search

Navigation