Indication and limitation of surgical treatment for hepatocellular carcinoma with tumor thrombus in the portal vein

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One hundred and fifty patients diagnosed on imaging modalities between January 1994 and September 2001 were studied in terms of survival to investigate the indication and limitation of surgical treatment for patients with hepatocellular carcinoma and portal vein tumor thrombus (PVTT). Hepatectomy was performed in 24 (16%). Using Cox's regression model, the following independent prognostic factors were determined. 1) liver damage C or ascites, 2) more than 4 intrahepatic nodules, 3) patients without hepatectomy, 4) patients without transcatheter arterial embolization (TAE). In 53 non-surgical patients with liver damage C or ascites, median survival period and 1-year survival rate were 2.3 months and 6%, respectively. In 17 surgical patients with liver damage A or B without ascites, having no more than 3 intrahepatic nodules, the 1-, 3-, 5-year survival rates were 77%, 57% and 48%, respectively. Six of the 17 survived more than 3 years. The comparative survival rates for 15 patients who received TAE were 33%, 20% and 13% suggesting the usefulness of hepatectomy for patients with PVTT. However, in 7 surgical patients with liver damage A or B without ascites, having more than 4 intrahepatic nodules, 6 died of cancer within twelve months. The result of 1-year survival rate was 14% in surgical patients and 21% in 24 patients who underwent TAE. The independent prognostic factors particular in patients who received surgery were hepatic vein tumor thrombus and tumor macroscopic type.

Indication and limitation of surgical treatment for hepatocellular carcinoma with tumor thrombus in the portal vein

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