T. Ochiai1, T. Sato1, Y. Ohata1, H. Ueda1, A. Oba1, K. Akahoshi1, K. Nakao1, T. Furuyama1, E. Katsuta1, H. Ito1, S. Matsumura1, A. Aihara1, D. Ban1, T. Irie1, A. Kudo1, S. Tanaka1, M. Tanabe1 1Tokyo Medical And Dental University,Hepato-Biliary-Pancreatic Surgery,Bunkyo-ku, Tokyo, Japan
Introduction: Hepatocellular carcinoma (HCC) is the most common type of primary liver tumor and is the fifth most common malignancy worldwide. The prognosis of patients with HCC accompanied by portal vein tumor thrombus (PVTT) is generally poor, therefore, the role of surgical resection for HCC with PVTT is controversial. This study aimed to evaluate the efficacy of initial surgery for HCC with PVTT and secondary treatments; hepatectomy, radiofrequency ablation (RFA), transcatheter arterial chemoembolization (TACE), chemotherapy, radiation, for recurrence after curative resection.
Methods: From April 2000 to December 2013, initial hepatic resection for 617 patients with HCC was performed at our hospital. Among these patients, a retrospective study was carried out on 79 patients (12.8%) with PVTT.
Results:The 1, 3- and 5-year overall survival rates were 65%, 41% and 38% in 66 patients who underwent curative resection and 18%, 0% and 0% in 13 patients who underwent non-curative surgery, respectively. Forty six patients with PVTT located in the segmental or sectoral portal vein showed significantly better survival than 20 with PVTT extended to right and/or left portal veins, the main portal vein or the superior mesenteric vein (Fig. 1). After initial curative resection, tumor recurrences were observed in 46 patients; 11 patients met Milan Criteria and 35 patients exceeded the criteria at first diagnosis of recurrence. Among 46 patients, 43 patients were treated by heaptectomy in 3 patients, RFA in 6, TACE in 16, or chemotherapy in 18. The overall survival was significantly better in hepatectomy and RFA than in TACE, chemotherapy and radiation.
Conclusion:Liver resection is justified in selected patients with PVTT located in the segmental or sectoral branches of the portal vein. Liver resection and RFA are suitable treatments for recurrence, however, 53% (35 of 66) of patients who underwent initial curative hepatectomy showed HCC recurrence that exceeded Milan criteria in this study. Effective adjuvant treatments need to be developed to counteract the high incidence of recurrence.
