Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

Hepatic Resection in Patients with Hepatocellular Carcinoma Accompanied by Portal Vein Thrombus

간문맥 혈전이 동반된 간세포암에서의 간절제술

  • Jung, Sung Min (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Ahn, Chul Soo (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Lee, Sung Gyu (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Lee, Young Joo (Department of Hepatobiliary Pancreatic Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Park, Kwang Min (Department of Hepatobiliary Pancreatic Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Hwang, Shin (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Kim, Ki Hun (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Moon, Deok Bog (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Ha, Tae Yong (Department of Liver Transplantation and Hepatobiliary Surgery, Asan Medical Center, Ulsan University College of Medicine)
  • 정성민 (울산대학교 의과대학 외과학교실 서울아산병원, 간이식 및 간담도외과) ;
  • 안철수 (울산대학교 의과대학 외과학교실 서울아산병원, 간이식 및 간담도외과) ;
  • 이승규 (울산대학교 의과대학 외과학교실 서울아산병원, 간이식 및 간담도외과) ;
  • 이영주 (울산대학교 의과대학 외과학교실 서울아산병원, 간담췌외과) ;
  • 박광민 (울산대학교 의과대학 외과학교실 서울아산병원, 간담췌외과) ;
  • 황신 (울산대학교 의과대학 외과학교실 서울아산병원, 간이식 및 간담도외과) ;
  • 김기훈 (울산대학교 의과대학 외과학교실 서울아산병원, 간이식 및 간담도외과) ;
  • 문덕복 (울산대학교 의과대학 외과학교실 서울아산병원, 간이식 및 간담도외과) ;
  • 하태용 (울산대학교 의과대학 외과학교실 서울아산병원, 간이식 및 간담도외과)
  • Published : 2011.02.28
⟨ Previous Next ⟩

Abstract

Purpose: Although surgical resection is the most effective treatment for hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombus (PVTT), the recurrence rate is very high and prognosis is poor. This retrospective analysis aimed to establish a surgical strategy for patients with portal vein thrombus and to identify predictors of tumor thrombus in these patients. Methods: From 2006 to 2007, 63 hepatocellular carcinoma patients with portal vein thrombus detected by preoperative imaging underwent hepatic resection, and their clinical data were retrospectively analyzed. Possible prognostic factors for survival were analyzed with postoperative survival curves, and significant factors were determined by univariate and multivariate analysis. Results: 31 patients (49.2%) with portal vein tumor thrombus were detected by pathologic reports in 63 HCC patients with portal vein thrombus. Significant prognostic factors included Serum Albumin ${\leq}$3.5 g/dl, Alkaline phosphatase (ALP)${\geq}$100 IU/L, Tumor size${\geq}$10 cm, non-expanding type, PVTT and Alpha-feto protein (AFP)${\geq}$104 IU/L by univariate analysis. Independent prognostic factors included PVTT. Conclusion: PVTT is not always detected in patients with HCC accompanied by portal vein thrombus. Although patients have a portal vein tumor thrombus, some patients have greater long-term survival. Hepatic resection should be considered for patients with portal vein thrombus.

Keywords

References

  1. Llovet JM. Updated treatment approach to hepatocellular carcinoma. J Gastroenterol 2005;40:225-235. https://doi.org/10.1007/s00535-005-1566-3
  2. Llovet JM, Bustamante J, Castells A, et al. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 1999;29:62-67. https://doi.org/10.1002/hep.510290145
  3. Villa E, Moles A, Ferretti I, et al. Natural history of inoperable hepatocellular carcinoma: estrogen receptors' status in the tumor is the strongest prognostic factor for survival. Hepatology 2000;32:233-238. https://doi.org/10.1053/jhep.2000.9603
  4. Minagawa M, Makuuchi M. Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus. World J Gastroenterol 2006;12:7561-7567. https://doi.org/10.3748/wjg.v12.i47.7561
  5. Lau WY, Lai EC. Hepatocellular carcinoma: current management and recent advances. Hepatobiliary Pancreat Dis Int 2008;7:237-257.
  6. 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;233:379-384. https://doi.org/10.1097/00000658-200103000-00012
  7. Fukuda S, Okuda K, Imamura M, Imamura I, Eriguchi N, Aoyagi S. Surgical resection combined with chemotherapy for advanced hepatocellular carcinoma with tumor thrombus: report of 19 cases. Surgery 2002;131:300-310. https://doi.org/10.1067/msy.2002.120668
  8. Inayoshi J, Ichida T, Sugitani S, et al. Gross appearance of hepatocellular carcinoma reflects E-cadherin expression and risk of early recurrence after surgical treatment. J Gastroenterol Hepatol 2003;18:673-677. https://doi.org/10.1046/j.1440-1746.2003.03021.x
  9. Nakashima Y, Nakashima O, Tanaka M, Okuda K, Nakashima M, Kojiro M. Portal vein invasion and intrahepatic micrometastasis in small hepatocellular carcinoma by gross type. Hepatol Res 2003;26:142-147. https://doi.org/10.1016/S1386-6346(03)00007-X
  10. Kim CH, Choi GH, Han DH, et al. The outcome after Curative Resection for a Huge (>10 cm) Hepatocellular Carcinoma. Korean Journal of HBP Surgery 2008;12:238-244.
  11. Dodd GD 3rd, Memel DS, Baron RL, Eichner L, Santiguida LA. Portal vein thrombosis in patients with cirrhosis: does sonographic detection of intrathrombus flow allow differentiation of benign and malignant thrombus? AJR Am J Roentgenol 1995;165:573-577. https://doi.org/10.2214/ajr.165.3.7645473
  12. Ricci P, Cantisani V, Biancari F, et al. Contrast-enhanced color Doppler US in malignant portal vein thrombosis. Acta Radiol 2000;41:470-473. https://doi.org/10.1080/028418500127345703
  13. Pandey D, Lee KH, Wai CT, Wagholikar G, Tan KC. Long term outcome and prognostic factors for large hepatocellular carcinoma (10 cm or more) after surgical resection. Ann Surg Oncol 2007;14:2817-2823. https://doi.org/10.1245/s10434-007-9518-1
  14. Shah SA, Wei AC, Cleary SP, et al. Prognosis and results after resection of very large (> or=10 cm) hepatocellular carcinoma. J Gastrointest Surg 2007;11:589-595. https://doi.org/10.1007/s11605-007-0154-7
  15. Zhou YM, Yang JM, Li B, et al. Risk factors for early recurrence of small hepatocellular carcinoma after curative resection. Hepatobiliary Pancreat Dis Int 2010;9:33-37.
  16. Liang LJ, Hu WJ, Yin XY, et al. Adjuvant intraportal venous chemotherapy for patients with hepatocellular carcinoma and portal vein tumor thrombi following hepatectomy plus portal thrombectomy. World J Surg 2008;32:627-631. https://doi.org/10.1007/s00268-007-9364-0
  17. Zhou J, Tang ZY, Wu ZQ, 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;53:275-280.
  18. Ikai I, Hatano E, Hasegawa S, et al. Prognostic index for patients with hepatocellular carcinoma combined with tumor thrombosis in the major portal vein. J Am Coll Surg 2006; 202:431-438. https://doi.org/10.1016/j.jamcollsurg.2005.11.012
  19. Ikenaga N, Chijiiwa K, Otani K, Ohuchida J, Uchiyama S, Kondo K. Clinicopathologic characteristics of hepatocellular carcinoma with bile duct invasion. J Gastrointest Surg 2009;13:492-497. https://doi.org/10.1007/s11605-008-0751-0
  20. Kumada K, Ozawa K, Okamoto R, et al. Hepatic resection for advanced hepatocellular carcinoma with removal of portal vein tumor thrombi. Surgery 1990;108:821-827.
  21. Ochiai T, Takayama T, Inoue K, et al. Hepatic resection with and without surgical margins for hepatocellular carcinoma in patients with impaired liver function. Hepatogastroenterology 1999;46:1885-1889.
  22. Hashimoto T, Minagawa M, Aoki T, et al. Caval invasion by liver tumor is limited. J Am Coll Surg 2008;207:383-392. https://doi.org/10.1016/j.jamcollsurg.2008.02.017
  23. Kondo K, Chijiiwa K, Kai M, et al. Surgical strategy for hepatocellular carcinoma patients with portal vein tumor thrombus based on prognostic factors. J Gastrointest Surg 2009;13:1078-1083. https://doi.org/10.1007/s11605-009-0854-2
  24. Ishikawa T, Imai M, Kamimura H, et al. Improved survival for hepatocellular carcinoma with portal vein tumor thrombosis treated by intra-arterial chemotherapy combining etoposide, carboplatin, epirubicin and pharmacokinetic modulating chemotherapy by 5-FU and enteric-coated tegafur/uracil: a pilot study. World J Gastroenterol 2007;13:5465-5470. https://doi.org/10.3748/wjg.v13.i41.5465
  25. Kamiyama T, Nakanishi K, Yokoo H, et al. Efficacy of preoperative radiotherapy to portal vein tumor thrombus in the main trunk or first branch in patients with hepatocellular carcinoma. Int J Clin Oncol 2007;12:363-368. https://doi.org/10.1007/s10147-007-0701-y